fornia 

»nal 

.ty 


•  '' 


THERAPEUTIC  SUGGESTION 


IN 


PSYCHOPATHIA  SfiXUALIS 

(PATHOLOGICAL  MANIFESTATIONS  OF  THE  SEXUAL  SENSE), 

WITH  ESPECIAL  REFERENCE  TO 

CONTRARY  SEXUAL  INSTINCT. 

BT 

Dr.  A.  von  SCHRENCK-NOTZING, 


PRACTICING  PHYSICIAN   IN   MUNICH. 


Tira.tasla.tion. 


CHARLES    GILBERT    CHADDOCK,    M.D., 

PROFESSOR  OF  DISEASES  OF    THE   NERVOUS  SYSTEM,   MARION-SIMS  COLLEGE  OF  MEDICINE;     MEMBER  OF  THE  AMERICAN 

MEDICO-PSYCHOLOGICAL    ASSOCIATION;     MEMBER   OF   THE   ST.    LOUIS    MEDICAL    SOCIETY;     ATTENDING 

NEUROLOGIST  TO  THE  REBEKAH   HOSPITAL  :   FELLOW  OF  THE  CHICAGO  ACADEMY 

OF    MEDICINE;    CORRESPONDING-  MEMBER  OF  THE    DETROIT 

ACADEMY   OF   MEDICINE,   ETC. 


'•' 


PHILADELPHIA  : 

THE  P.  A.  DAVIS  COMPANY,  PUBLISHERS. 

LONDON : 

F.  J.  REBMAN. 
1895. 


COPYRIGHT,  1895, 


THE  F.  A.  DAVIS  COMPANY. 


[Registered  at  Stationers'  Hall,  London,  England.] 


Philadelphia,  Pa.,  U.  8.  A. 

The  Medical  Bulletin  Printing-House, 

1916  Cherry  Street. 


DEDICATED 


DR.  AUGUST  FOREL, 

PROFESSOR  or  PSYCHIATRY  IN  THE  UNIVERSITY  OF  ZURICH  AND  DIRECTOR  OF  THE  ASYLCM 
FOR  THE  INSANE  AT  BDRGHOLZLI, 


RESPECT  AND  GRATITUDE, 

BT 

THE  AUTHOR. 


PREFACE. 


THIS  work  owes  its  existence  to  observations  of  the  effects 
of  therapeutic  suggestion  upon  individuals  subject  to  contrary 
sexuality.  The  favorable  results  obtained  in  "  congenital"  urn- 
ings  by  psychical  treatment  in  the  hypnotic  state  placed  before 
me  the  alternative  either  to  assume  that  suggestion  is  capable 
of  influencing  congenital  abnormalities  of  the  mind  or  to  prove 
that  in  the  idea  of  homo-sexuality  at  present  prevalent  the 
hereditary  factor  is  overestimated,  to  the  disadvantage  of  educa- 
tional influences.  Thus  it  became  necessary  to  examine  more 
carefully  the  etiology  and  pathogenesis  of  the  perverse  tenden- 
cies of  the  sexual  life.  Onanism  and  functional  (psychical  or 
relative)  impotence,  as  constant  accompaniments  of  sexual  per- 
versions, likewise  demanded  more  thorough  study ;  and  in  this 
work,  in  separate  sections,  they  are  considered  both  pathologi- 
cally and  therapeutically,  as  far  as  is  necessary  for  an  under- 
standing of  parsesthesia  sexualis. 

But  the  phenomena  of  sexual  anaesthesia  and  uranism  in 
the  female  sex  could  be  given  but  brief  consideration, — first, 
because  .in  medical  practice  and  social  life  they  have  attained 
nothing  like  the  importance  of  male  homo-sexuality ;  and, 
secondly,  because,  owing  to  the  infrequency  of  these  anomalies, 
I  have  had  no  opportunity  for  personal  observation  of  them. 

Thus,  the  title  of  the  book,  strictly  speaking,  does  not 
correspond  exactly  with  its  contents ;  for  it  emphasizes  only  the 
therapeutic  aspect,  and  should  really  be :  "Pathological  and 
Suggestive  Therapeutic  Studies  of  the  Abnormal  Manifestations 
of  the  Sexual  Instinct."  But  the  title  used  was  chosen  for  the 
sake  of  brevity,  and  to  indicate  that  the  studies  of  the  patho- 
logical side  of  the  subject  became  essential  only  from  a  thera- 
peutic stand-point ;  in  other  words,  that,  to  a  certain  extent, 
they  are  the  foundation  for  a  correct  comprehension  of  the 
therapeutics  of  the  subject. 

Among  the  most  important  tasks  confronting  neuro- 

(v) 


VI  PREFACE. 

pathology,  and  one  offering  richest  returns,  is  undoubtedly 
the  establishment  of  precise  indications  for  the  employment  of 
psychical  therapeutics ;  to  which  Wilhelm  Erb,  with  clearness 
of  view,  has  lately  called  attention,  both  with  reference  to  psy- 
chical treatment  in  the  waking  state,  as  well  as  to  hypnotic 
suggestion.1  Though,  in  spite  of  the  obstinate  opposition  and 
continued  indifference  of  prominent  clinicians,  all  the  greater 
series  of  experiments  of  late  years  agree  in  demonstrating  that 
with  necessary  precautions  hypnotic  suggestion,  used  for  reme- 
dial purposes,  after  the  methods  of  "  Liebeault,  Bernheim,  and 
Forel,"  is  an  effective  and  harmless  therapeutic  agent ; 2  and 
though  thus  the  question  concerning  the  justification  of  hyp- 
notic suggestion  and  its  admission  among  the  available  means 
of  our  therapeutic  armamentarium  may  at  last  be  regarded  as 
settled,  yet  the  exact  determination  of  the  sphere  of  thera- 
peutic operation  of  hypnotic  suggestion  may  be  regarded  as  the 
second  important  part  of  the  problem  to  be  solved.  Experi- 
mentation in  the  most  heterogeneous  domains  of  disease — 
external  and  internal,  organic  and  functional — has  now  to 
establish  a  place  for  systematic  application  of  suggestion  in 
functional  disturbances  of  certain  kinds,  by  the  side  of  other 
remedial  measures,  with  exact  valuation  and  comparison. 

1  Wilhelm  Erb,  "  Die  nachten  Aufgaben  der  Nervenpathologie,"  Deutsche  Zeitschrift 
fur  Nervenheilkunde,  Vogel,  Leipzig,  1891,  p.  3. 

5  (a)  Comp.  Ringier  :  Erfolge  des  therapeutischen  Hypnotismus  in  der  Landpraxis 
(Lehmann,  Miinchen,  1891).  The  author  reviews  210  cases  in  his  practice,  which  fulfill 
all  requirements  with  reference  to  details  of  description,  numerical  grouping,  continuance 
of  observation  after  discharge,  etc.  He  has  never  seen  hypnosis  have  an  injurious 
influence. 

(6)  Van  Renterghem  and  von  Eeden  :  Comte  rendu  des  r6sultats  obtenus  pendant  la 
premiere  periode  bisannuelle,  1887-1889  (Brussels,  Manceaux).  The  authors,  whose  clinic 
I  visited  in  1891,  likewise  testify  to  the  innocuousness  of  therapeutic  hypnosis,  and  were 
able  to  add  nearly  1000  cases  to  the  414  cases  of  the  article  cited,  which  had  since  been 
studied. 

(c)  Wetterstrand,  according  to  his  work,  "  Der  Hypnotismus  und  Seine  Anwendung 
in  der  praktischen  Medicin  "  (Urban  und  Schwarzenberg,  Leipzig  and  Vienna),  in  the 
course  of  the  last  few  years,  has  subjected  3200  persons  to  hypnotic  procedures,  and  induced 
hypnosis  some  60,000  times,  without  observing  any  injurious  results. 

(rf)  Von  Corval  ("  Suggest! vetherapie,"  Realencyclopadie  der  gesammten  Heil- 
kunde,  von  Eulenburg,  Eucyclopad.  Jahrbucher,  Bd.  i,  Urban  and  Schwarzcnberir)  gives 
a  complete  review  of  this  branch  of  therapeutics,  and,  from  liis  own  as- well  as  from  the 
experience  of  others  in  general,  comes  to  the  conclusion  that  hypnosis,  correctly  employed, 
is  unaccompanied  by  any  danger. 


PREFACE.  VU 

If,  as  Erb  justly  remarks,  this  limitation  to  certain  fields 
dispels  many  illusions ;  still,  the  results  ot  such  investigations 
are  incomparably  more  valuable  to  science  than  the  generaliza- 
tion which  looks  upon  suggestion  as  a  "  panacea."  Thus  it 
will  be  necessary  next  to  arrange  the  suggestive-therapeutic 
material  after  the  manner  as  yet  used  but  by  two  observers, 
Van  Renterghem  and  Ringier  (compare  foot-note),  which  is 
followed  in  this  work. 

The  duration  of  the  effects  of  suggestive  treatment  seems 

of  great  importance.     Like  Ringier,  the  author  gave  especial 

t 

(e)  Minde,  in  his  learued  work,  "  Ueber  Hypnotismus  "  (Diepolder,  Miiuchen,  1891), 
which  is  supplied  with  many  important  proofs  taken  from  literature  (p.  62),  speaks  of  the 
"  dangers  "  of  inducing  hypnosis.  According  to  him,  these  result  from  light-minded  play, 
thoughtless  experimentation,  and  the  desire  to  satisfy  curiosity  and  vanity  by  public  ex- 
hibitions for  amusement,  and  they  are  usually  to  be  ascribed  to  dilettautic  awkwardness  or 
incorrect  methods,  or  to  auto-suggestion  in  the  subjects.  Minde  also  thinks  (p.  66)  these 
dangers  may  all  be  avoided  with  proper  care. 

(/)  Prof,  von  Krafft-Ebing  expresses  his  views  on  this  point  in  his  last  article  on 
hypnotism  ("  Zur  Verwerthung  der  Suggestionstherapie  in  Psychosen  und  Neurosen," 
Wiener  klin.  Wochenschrift,  1891,  No.  43),  in  the  following  words  :  "  Treatment  by  hyp- 
notic suggestion,  according  to  my  experience,  I  must  state,  is  innocuous  when  it  is  scien- 
tifically employed  with  due  reference  to  the  circumstances  of  the  individual  case." 

(<7)  Preyer  (Hypnotismus,  "  Vorlesungen,"  Urban  and  Schwarzenberg,  Leipzig  and 
Vienna,  1890,  p.  146)  also  warmly  commends  the  employment  of  hypnotic  suggestion,  and 
thinks  that  "  it  can  have  an  injurious  effect  only  when  unskillfully  used." 

(A)  Li6beault,  who  during  thirty  years  has  hypnotized  10,000  persons  (some  of  them 
more  than  100  times),  ascribes  his' early  "petits  malheurs  "  to  incorrect  procedure;  and 
with  proper  precaution  he  has  never  observed  untoward  effects  to  follow  hypnosis.  Comp. 
Revue  de  1'hypnot.,  i,  p.  105  et  seq. 

(t)  Professor  Bernheim,  from  his  observations  on  several  thousand  patients,  has 
lately  expressed  himself  as  follows  :  "  Suggestion  often  cures;  when  it  does  not  cure,  it  ameli- 
orates;  and  if  it  does  not  benefit,  it  is  still  harmless."  Comp.  Hypnotisme,  Suggestion,  Psy- 
chotherapie,  Doin,  Paris,  1891,  p.  18. 

(/fc)  Grossmann  used  hypnosis  in  30  cases  of  influenza,  and  found  the  legend  of 
its  dangers  unconfirmed  ;  on  the  contrary,  he  characterizes  suggestion  as  a  powerful  means 
of  cure.  Comp.  Grossmann,  Die  Enfolge  der  Suggestionstherapie  bei  Influenza,  Brieger, 
Berlin,  1892,  p.  2. 

(I)  Professor  Hirt  (Breslau),  from  August,  1889,  to  the  middle  of  April,  1890,  made 
hypnotic  experiments  for  therapeutic  purposes  on  598  persons.  More  than  4000  sittings  have 
proved  to  him  that  hypnosis  is  never  accompanied  by  harmful  effects,  even  when  frequently 
induced  in  the  same  individual.  On  the  other  hand,  Hirt  is  greatly  opposed  to  allow  ing 
the  laity  and  unqualified  persons  to  practice  it ;  and  he  warns  against  premature  and  erro- 
neous judgments  of  it,  which  are  only  too  willingly  credited  by  those  unqualified  to  form  an 
opinion.  Comp.  Wiener  med.  Wochenschrift,  1890,  Nos.  27  and  30. 

(TO)  The  evidence  mentioned  is  augmented  by  the  wide  experiences  of  Forel,  Moll, 
and  numerous  other  experimenters,  all  of  which  leads  to  the  conclusion  that,  with  proper 
individualization  of  hypnotism  for  therapeutic  purposes,  it  is  devoid  of  any  disadvantages. 

Observations  of  the  author  on  more  than  300  persons,  of  whom  many  were  hypno- 
tized more  than  100  times  and  some  200  or  300  times,  also  speak  in  favor  of  the  harm- 
lessness  of  therapeutic  suggestion. 


Vlll  PREFACE. 

attention  to  the  duration  of  the  suggestive-therapeutic  results 
after  cessation  of  treatment.  Many  of  the  patients  were  very 
soon  beyond  observation,  and  therefore,  with  the  best  of  will, 
it  was  impossible  to  obtain  late  reports  of  all  of  them.  Never- 
theless, it  has  been  possible  for  the  author,  as  it  has  been  for 
Prof,  von  Krafft-Ebing,  to  continue  to  observe  many  patients 
for  several  years  after  cessation  of  treatment.  In  one  of  the 
author's  cases  the  time  of  observation  after  discharge  was  two 
years  and  seven  months,  and  in  several  other  cases  about  one 
year  and  eight  months.  Thus  the  tables  here  are  made  to 
indicate  cases  of  "  recovery  with  later  reports,"  and  cases  of 
"  recovery  without  later  reports." 

Where  possible,  for  the  sake  of  objectivity,  I  have  allowed 
patients  to  speak  lor  themselves,  and  give  their  letters  verbatim. 
The  custom,  which  is  certainly  justified,  of  believing  in  the 
reality  of  disease  in  many  cases  only  when  a  pathologico-ana- 
tomical  substratum  is  appreciable  and  demonstrable  to  our 
senses,  even  with  but  slight  functional  disturbance,  has  led  many 
physicians  to  regard,  in  a  one-sided  manner,  states  of  subjective 
disturbance  without  such  substratum  in  many  patients  ;  and  to 
distrust  their  testimony  concerning  subjective  symptoms,  as  well 
as  their  statements  concerning  favorable  changes  in  such  symp- 
toms. Self-deception  in  the  patient,  unconscious  auto-suggestion 
on  the  part  of  the  physician,  exaggeration  of  the  results  on  both 
sides,  and  many  similar  phrases  are  not  infrequently  heard 
instead  of  well-founded  objections.  In  reply  to  this  it  may 
be  stated:  The  reader  may  form  his  own  judgment  of  the 
conscientiousness  and  objectivity  of  the  descriptions,  from  the 
histories  of  the  cases.  On  this  point  I  fear  that  by  pedantic 
communication  of  details  which,  perhaps,  are  interesting  only 
in  a  negative  way,  I  have  made  great  demand  upon  the  patience 
of  my  readers;  but  I  hope  that  my  effort  to  describe  actual  facts 
as -exactly  as  possible  will  at  least  receive  recognition.  As  for 
the  second  objection,  an  opponent  using  such  an  argument 
would  also  be  driven  to  deny  the  existence  of  pain,  for  which 
we  have  no  appreciable  objective  substratum.  But  what  other 
evidences  of  pain  are  there  than  the  statements  and  gestures  of 


PREFACE.  IX 

the  patient,  which  also  hold  for  the  majority  of  disturbances  of 
the  sensory  sphere,  for  psychoses,  etc.  I  And  though  a  com- 
mendable attempt  has  lately  been  made  to  establish  objective 
signs  in  certain  cases  of  neurasthenia,  still,  in  his  work,  Lowen- 
feld1  designates  neurasthenia  as  that  affection  for  which  the  very 
absence  of  objective  symptoms  is  characteristic.  The  untenable- 
ness  of  such  objections  as  those  mentioned  is  so  evident  that 
more  extended  discussion  of  them  would  be  superfluous. 

It  may  be  questioned  whether  it  is  justifiable  to  discuss 
the  anomalies  of  the  sexual  instinct  apart,  instead  of  treating 
of  them  in  their  proper  place  in  psychiatry.  As  a  rule,  they 
are  certainly  only  symptoms  of  a  constitutional  malady  or  of 
a  weakened  state  of  the  brain,  which  present  themselves  in  the 
various  forms  of  sexual  perversion. 

Moreover,  attention  has  been  directed  to  the  baneful  influ- 
ence possibly  exerted  by  such  publications  as  "  Psychopathia 
Sexualis."  To  be  sure,  the  appearance  of  seven  editions  of  the 
book  could  not  be  accounted  for,  were  its  circulation  confined 
to  scientific  circles.  Therefore,  it  is  not  to  be  denied  that  a 
pornographic  interest  on  the  part  of  the  public  is  accountable 
for  a  part  of  its  wide  circulation.  But,  in  spite  of  this  disad- 
vantage, the  injury  done  by  implanting  knowledge  of  sexual 
pathology  in  unqualified  individuals  is  not  to  be  compared 
with  the  good  accomplished.  History  shows  that  uranism  was 
very  wide-spread  long  before  the  appearance  of  "  Psychopathia 
Sexualis."  The  courts  have  constantly  to  deal  with  sexual 
crimes,  in  which  the  responsibility  of  the  accused  comes  in 
question.  For  the  physician  himself,  the  sexual  anomalies, 
treated  as  they  are  in  text-books  on  psychiatry  in  a  distant 
manner,  are  in  greater  part  a  terra  incognita.  Exact  knowledge 
of  the  causes  and  conditions  of  development  of  sexual  aberra- 
tions, and  of  the  influence  on  them  of  hereditary  constitution, 
education,  the  impressions  of  every-day  life,  and  our  modern, 
refined  civilization,  is  the  pre-requisite  for  a  rational  prophy- 
laxis of  sexual  aberrations  and  a  correct  sexual  education. 
Without  careful  study  of  the  circumstances  which  attend  the 

1  Lowenfeld  :  Die  objectiven  Zeichen  der  Neurasthenic,  Lehmann,  Munchen,  1892. 


X  PREFACE. 

development  of  sexual  anomalies,  we  should  never  be  in  a  po- 
sition to  use  effectual  therapeutic  means.  The  majority  of  these 
unfortunate  patients — von  Krafft-Ebing  calls  them  Nature's 
step-children — are  devoid  of  insight  into  their  malady ;  like  in- 
sane patients  destitute  of  understanding  of  the  ethical  develop- 
ment of  man,  they  are  happy  in  their  abnormal  instinctive 
tendency.  For  this  reason,  in  spite  of  the  great  prevalence  of 
uranism,  very  few  of  its  subjects  seek  medical  treatment. 
While  the  terminal  forms  of  abnormal  sexuality  end  in  asylums 
for  the  insane,  the  doubtful  cases,  in  which  incompleteness  of 
development  or  apparent  viciousness  renders  correct  diagnosis 
difficult,  make  up  the  majority.  But  a  thorough  knowledge  of 
the  aberrations  of  the  sexual  instinct  is  absolutely  indispensable 
to  the  jurist.  The  reasons  given  are  thus  sufficiently  important 
to  prove  the  need  for  a  hand-book  on  "psychopathia  sexualis." 

But  a  thorough  treatment  of  the  subject  seems  even  more 
important  in  the  light  of  the  theory  of  suggestion.  Thanks  to 
therapeutic  nihilism,  which,  unfortunately,  still  finds  numerous 
adherents  among  physicians,  until  now  such  patients  have  re- 
mained the  life-long  victims  of  their  imperative  feelings,  and 
not  infrequently  have  finally  seen  themselves  placed  before  the 
alternatives  of  the  prison  or  the  asylum ;  to  say  nothing  of  a 
consciousness,  ever  more  acutely  felt  with  advancing  years,  of  a 
useless  existence, — at  least,  as  far  as  the  foundation  of  a  family 
is  concerned. 

By  means  of  suggestion,  especially  by  its  application  in  the 
hypnotic  state,  the  possibility — this  much  may  be  said  with  cer- 
tainty from  the  seventy  cases  detailed  in  this  work — is  demon- 
strated to  us  that  aberrations  of  instinctive  life  from  its  proper 
channel  may  be  corrected. 

The  manifestations  mentioned  may  be  regarded  as  impera- 
tive sensations  and  imperative  ideas,  which  occur  either  as  pure 
auto-suggestion  or  have  their  origin  in  organic  conditions.  The 
ideational  stimuli,  induced  in  the  brain  by  suggestion  from  an- 
other, are  in  a  measure  imperative  ideas  in  statu  nascendi,  which 
— assisted  by  the  law  of  the  ideomotor  and  ideodynamic  reflex 
transference,  with  individually  suitable  and  correct  wording, 


PREFACE.  XI 

and,  in  case  of  necessity,  with  cumulative  application  in  re- 
peated sittings — gradually  gain  irresistible  power  over  the  pa- 
tients, and  thus  finally  assume  auto-suggestive  direction  of  their 
conduct.  According  to  this  we  are  able  to  remove  by  sugges- 
tion abnormal  moods,  affects,  feelings,  instincts,  ideas,  and  even 
hallucinations  and  illusions.  The  suggestive  influence,  how- 
ever, reaches  its  limits  in  inherited  constitution  or  predis- 
position of  the  brain,  having  its  root  in  "organic  conditions; 
and  likewise  in  "  phenomena  having  a  very  deep  foundation  in 
the  psychical  mechanism  "  (von  KrafFt-Ebing). 

The  proof  offered  by  me  in  this  book,  that  a  much  larger 
proportion  of  sexual  aberrations  than  has  heretofore  been  pre- 
sumed is,  in  pathogenesis,  to  be  referred  to  external  conditions 
(accidental  causes,  education),  opens  to  psycho-therapeutics  a 
much  wider  field  in  this  class  of  cases,  with  points  of  departure 
essentially  much  more  favorable.  In  spite  of  the  great  difficul- 
ties which  frequently  enough  attend  the  treatment  of  such  pa- 
tients, it  will  become  a  hopeful  and  productive  task  for  the 
therapeutics  of  the  future. 

For  the  stimulus  to  the  study  of  this  subject,  I  am  espe- 
cially indebted  to  the  well-known  work  of  Prof,  von  Krafft- 
Ebing,  which  has  been  constantly  by  my  side  as  a  guide  in 
these  questions ;  and  if  in  some  points  the  results  of  my  studies 
do  not  accord  with  those  of  my  highly-honored  teacher,  my 
indebtedness  is  thus  increased,  since  in  the  cases  of  his  book 
I  found  the  way  indicated  which  has  been  followed  in  this  work. 

The  humane  purpose  of  this  work  with  reference  to  ther- 
apeutics, as  well  as  the  effort  to  arrive  at  an  unprejudiced  ex- 
planation and  truth,  should  be  sufficient  to  overcome  any  scru- 
ples to  which  the  sexual  character  of  the  subject  might  give 
rise.  This  circumstance  made  it  especially  obligatory  for  the 
author  to  carefully  avoid  anything  like  a  popular  style  of  ex- 
pression, and  to  preserve  as  carefully  as  possible,  in  spirit  and 
letter,  the  scientific  character  of  the  work. 

When  one  considers  the  difficulties  which  suggestive  ther- 
apeutics has  still  to  encounter  in  the  larger  part  of  the  public, 
and  how  few  psycho-sexual  cases  apply  to  the  physician, — not  to 


Xll  PREFACE. 

speak  of  their  asking  for  treatment,  especially  hypnotic  treat- 
ment,— then  a  series  of  seventy  cases,  therapeutically  considered, 
forms  a  basis,  in  a  measure,  sufficient  for  the  formation  of  a 
judgment  concerning  the  prospect  of  cure  of  such  patients, 
especially  when  the  long  duration  and  care  of  observation  in  a 
number  of  cases  is  also  taken  into  account. 

Of  the  70  therapeutic  observations  detailed  in  this  work, 
22  have  already  appeared  in  various  publications,  journals, 
books,  etc.,  viz.:  Cases  9,  31,  32,  39,  40,  41,42,  43,  44,  45,  46, 
47,  50,  53,  54,  55,  56,  57,  58,  59,  60,  61. 

Twenty-four  cases  have  been  placed  at  my  disposal,  in 
manuscript,  for  use  in  this  work,  by  recognized  specialists  in 
the  field  of  suggestive  therapeutics,  viz. :  Cases  1,  2,  3,  4,  5,  6, 
7,  8,  17,  19,  21,  22,  23,  24,  25,  26,  27,  28,  29,  30,  48,  49, 
51,  52. 

In  addition,  there  are  24  cases  of  my  own,  of  which 
but  one  has  yet  been  published  (in  von  Krafft-Ebing's 
" Psychopathia  Sexualis,"),  viz.:  Cases  10,  11,  12,  13,  14, 
15,  16,  18,  20,  33,  34,  35,  36,  37,  38,  62,  63,  64,  65,  66, 
67,  68,  69,  70. 

As  a  rule,  the  authors  made  use  of  the  Bernheim-Liebeault 
methods  of  hypnosis,  where  nothing  particular  is  stated  on  this 
point. 

In  order  to  estimate  the  depth  of  hypnosis,  Liebeault  has 
recommended  its  division  into  six  degrees,  Professor  Bernheim 
into  nine,  and  Professor  Forel  into  three.  The  material  of  this 
work  is  arranged  in  accordance  with  the  division  into  three 
degrees,  and  follows  this  schema: — 

I.  Somnolence. — The   individual    but   slightly   influenced, 
with  the  use  of  all  his  energy  is  still  able  to  resist  the  sugges- 
tion and  open  his  eyes.     Consciousness  intact. 

II.  Hypotaxis. — The  individual  is  no  longer  able  to  resist 
suggestions.     No  amnesia. 

III.  Somnambulism.1 — With    the    manifestations    of    the 

1  In  order  to  give  an  idea  of  the  susceptibility  to  hypnosis  in  general,  I  give  here 
the  numerical  results  of  several  authors  for  comparison  with  my  own,  under  the  foregoing 
classification.  My  results,  up  to  November,  1890,  among  the  people  of  Munich,  were  as 
follow  : — 


PREFACE. 


Xlll 


second  degree  there  is  also  amnesia,  or  susceptibility  to  hallu- 
cination, or  both. 

Post-hypnotic  phenomena  occur  with  somnambulism,  and 
even  with  the  second  degree. 

Finally,  it  is  my  pleasant  duty  to  acknowledge  in  this 
place  my  indebtedness  to  all  those  who,  by  their  co-operation  in 
any  way,  have  assisted  in'the  production  of  this  book;  espe- 
cially to  my  honored  guide  and  teacher  in  the  domain  of  sug- 
gestive therapeutics,  Dr.  Forel,  Professor  of  Psychiatry  in 
Zurich,  to  whom  the  work  is  dedicated;  and,  further,  to  Dr. 
R.  von  Krafft-Ebing,  Professor  of  Psychiatry  and  Neurology 
in  Vienna,  for  his  repeated  encouragement  and  advice. 

Besides  those  named,  I  have  been  assisted  in  the  prepara- 
tion of  this  work — by  means  of  patients  kindly  sent  to  me,  by 
unpublished  histories  of  cases  placed  at  my  disposal,  and  by 
literary  communications  and  advice — by  the  following  gentle- 


Refractory, 

Somnolence, 

Hypotaxis, 

Somnambulism, 


Persons. 

29 
42 

ioo 

69 

240 


Per  Cent. 
12.08 
17.5 
41.67 
28.75 

100.00 


The  results  at  Nancy  (Liebeault),  Amsterdam  (Van  Renterghem),  and  in  Switzer- 
land (Ringier),  in  comparison,  are  as  follow: — 


Liebeault, 
1011  Persons. 

Liebeault, 
753  Persons. 

Van 

Renterghem, 
178  Persons. 

Ringier, 
221  Persons. 

Sohrenck- 
Notzing, 
240  Persons. 

Per  Cent. 

Per  Cent. 

Per  Cent. 

Per  Cent. 

Per  Cent. 

Refractory  .... 
Somnolence    .  .  . 
Hypotaxis   .... 
Somnambulism    . 

2.67 
3.26 
78.04 
16.02 

7.97 
10.09 
63.21 
18.73 

3.93 
5.06 
79.77 
11.24 

5.43 
7.24 
52.49 
34.84 

12.08 
17.50 
41.67 

28.75 

99.99 

100.00 

100.00 

100.00 

100.00 

•According  to  my  preliminary  summary,  the  susceptibility  to  hypnosis  of  8705  per- 
sons, of  various  nationalities,  is  shown  by  the  following  figures  : — 

Persons. 

Refractory, 519 

Somnolence, -'...-'.  2557 

Hypotaxis, 4316 

Somnambulism, 1313 


8705 


Per  Cent. 
=  6 
=  29 
=  49 
=  15 
100 


Advanced  years,  on  the  whole,  diminish  susceptibility,  while  the  figures  for  earliest 
youth  do  not  quite  reach  those  for  middle  life. 


XIV  PREFACE. 

men  :  Dr.  Bernheim,  Professor  of  Internal  Medicine  at  Nancy ; 
Dr.  Stumpf,  Professor  of  Philosophy  (Munich) ;  Dr.  Gussman 
(Stuttgart);  the  privat-docenten,  Dr.  Kopp  (Munich)  and  Dr. 
Max  Dessoir  (Berlin) ;  Dr.  Liebeault  (Nancy) ;  Dr.  Wetter- 
strand  (Stockholm);  Dr.  Van  Renterghem  (Amsterdam);  Dr. 
Rosenberg  (Carlsruhe) ;  Dr.  von  Hosslin  (Neuwittelsbach,  near 
Munich);  Max  OfFner  (Munich);  and  Mr.  X.  X.,  urn  ing. 

I  here  express-  my  thanks  to  them  all  for  their  friendly 
and  helpful  co-operation. 

THE  AUTHOR. 

MUNICH,  October,  1894. 


TRANSLATOR'S  PREFACE. 


THE  favorable  reception  given  von  Krafft-Ebing's  "  Psycho- 
pathia  Sexualis  "  induced  me  to  undertake  an  English  version 
of  the  work  by  von  Schrenck-Notzing.  The  views  for  which 
the  latter  contends  so  ably  are  in  striking  contrast  witli  those 
held  by  von  Krafft-Ebing,  and,  for  that  reason,  this  work 
deserves  to  be  placed  in  English  by  the  side  of  "  Psychopathia 
Sexualis."  The  importance  of  the  question  treated  in  these 
works  cannot  be  overestimated  ;  for  upon  the  decision  concern- 
ing the  influence  of  congenital  and  educational  factors  must 
rest  the  theory  and  art  of  human  culture.  In  the  study  of 
these  perversions  a  wide  field  is  opened  to  view,  disclosing  pos- 
sibilities which  therapeutic  nihilism  looked  upon  as  dreams. 

As  a  contribution  to  the  literature  of  suggestive  thera- 
peutics this  work  stands  without  a  rival,  in  view  of  the  duration 
of  the  observation  of  reported  cures. 

A  growing  experience  in  cases  of  sexual  perversion  but 
tends  to  confirm  me  in  von  Schrenck-Notzing's  views,  and  I 
hope  soon  to  make  an  original  contribution  to  the  literature  of 
this  subject. 

The  medico-legal  question  of  responsibility  in  sexual  per- 
versions is  one  of  great  importance,  and,  as  here  clearly  shown, 
is  to  be  decided  not  by  the  fact  of  perversion,  but  by  the 
psychical  condition  as  a  whole. 

CHARLES  GILBERT  CHADDOCK,  M.D. 

ST.  Louis,  Mo., 

December,  1894. 


(XV) 


TABLE  OF  CONTENTS. 


PAGE 

PREFACE,   .        .        .        .  iii-xiv 

SECTION   I. 

SEXUAL  HYPERESTHESIA,  .;,,..'.        .        .        ,        .  1-7  T 

CHAPTER   I. 

PATHOLOGY,        ...        .        .        .        .        ,        .        .        .  1-33 

A.  ONANISM,  .        .        •, '       .        .        .  •    .   .        .        .        .        .         2 

Causes  and  predisposition,  3  ;  forms,  7 ;  onanism  by  means  of  tactile 
excitation,  7 ;  through  psychical  stimuli,  9  ;  through  combination 
of  both,  12 ;  clangers  and  results  of  onanism,  15  ;  diagnosis,  26  ; 
prognosis,  27. 

B.  SATYRIASIS  AND  NYMPHOMANIA,        .         .        .        .        .'.     .       28 
Causes  and  symptoms,  29  ;  diagnosis  and  prognosis,  33. 

CHAPTER,  II. 

THERAPEUTIC  SUGGESTION  IN  THE  TREATMENT  OF  ABNORMAL  INTEN- 
SIFICATION OF  SEXUAL  DESIRE,    .  .        .        .         34-50 

Sexual  prophylaxis  and  education,  34 ;  other  methods  of  treatment, 
42  ;  psychical  treatment  in  the  waking  state,  44  ;  suggestive  psycho- 
therapy, 46. 

CHAPTER   III. 

CASES   ILLUSTRATING    SUGGESTIVE    TREATMENT  OF    SEXUAL  HYPER^ES- 

THESIA, -..-.'..'.'         51-77 

Onanism  through  tactile  stimuli,  Cases  1  to  16,  51  ;  onanism  through 
psychical  stimuli,  Cases  17  and  18,  64 ;  satyriasis  and  nympho- 
mania,  Cases  19  and  20,  68  ;  tabular  review,  73  ;  conclusions,  74. 

SECTION  II. 

SEXUAL  IMPOTENCE  AND  ANESTHESIA,      ..  .        .        .       78-116 

CHAPTER   IV. 

PATHOLOGY, ••'•..-       •    '   •        •         78-91 

Physiology,  78 ;  causes  and  forms  of  impotence,  79 ;  female  impo- 
tence, 84  ;  diagnosis,  90  ;  prognosis,  90. 

(xvii) 


Xviii  TABLE   OF   CONTENTS. 

CHAPTER   V. 

PA  OK 

THE  ROLE  OF   SUGGESTIVE   THERAPEUTICS  IN   THE   TREATMENT  OF 

FUNCTIONAL  SEXUAL  WEAKNESS,        .        .        .        .          92-98 
Methods  of  treatment,    92 ;  suggestion   in   the   method   of  Brown- 
Sequard,  93  ;  psycho-therapy,  94 ;  waking  suggestion  and  hypnotic 
treatment,  96. 

CHAPTER   VI. 

CASES  ILLUSTRATING   SUGGESTIVE   TREATMENT  OF  SOME  FORMS  OF 

IMPOTENCE, .  99-116 

Therapeutic  results  in  psychical,  functional,  relative,  and  paralytic 
impotence,  Cases  21  to  38,  99  ;  tabular  review,  114 ;  conclusions,  113. 

SECTION   III. 

SEXUAL  PAR.ESTHESIA,      .        .        .        ....        .        .     117-305 

CHAPTER   VII. 

THE    FORMS    OF    SEXUAL    PERVERSION  WITH    REFERENCE  TO  THE 

THEORY  OF  VON  KRAFFT-EBING, 117-123 

Definitions  and  classification,  117  ;  inversion  of  sexual  feeling,  118 ; 
perverse  activity  of  the  sexual  instinct  without  reference  to  its 
object,  120. 

CHAPTER   VIII. 

THE  HISTORY  OF  THE  DEVELOPMENT  OF  CONTRARY  SEXUAL  FEELING 

AMONG  THE  ANCIENTS,         .        .        .        .        .        .      123-144 

Age  and  extent  of  sexual  inversion,  123  ;  historical  conditions  of 
development,  124  ;  pederasty  as  a  cause  of  homo-sexuality  and  castra- 
•  tion,  126  ;  eunuchism,  128  ;  the  historical  origin  of  uranism  in  Europe, 
130 ;  Greek  boy-love,  130 ;  impure  male-love  in  Greece,  135 ; 
GiJXeia  vowrot,  136  ;  spontaneous  origin  and  cultivation  of  the  feminine 
type  in  the  male,  137  ;  views  of  some  ancient  writers  concerning  the 
pathicus,  139 ;  conclusions,  142. 

CHAPTER   IX. 

HEREDITY  AND  EDUCATION  IN  THEIR  ETIOLOGICAL  RELATIONS  TO  SEX- 
UAL PERVERSIONS,        . 145-191 

Importance  of  heredity,  145  ;  hereditary  predisposition  in  general, 
146  ;  predisposition  and  pathogenetic  excitants,  147  ;  heredity  and 
exciting  causes  in  insanity,  148  ;  development  of  sexual  instinct,  150  ; 
pathological  determination  of  undiflferentiated  sexual  feeling  by  ex- 
ternal excitants,  151  ;  hereditary  lack  of  resistive  power,  and  patho- 
logical association,  154  ;  psycho-sexual  diseases,  moral  insanity,  and 


TABLE   OF   CONTENTS.  XIX 

weak-mindedness,  155  ;  transitional  cases  and  lessened  responsibility, 
157  ;  sexual  instinct  in  imbeciles,  158  ;  original  disposition  in  paraes- 
thesia  sexualis,  and  its  proofs,  158;  objections,  160;  tbe  etiological 
role  of  educational  factors  and  imagination,  161  ;  the  exciting  causes 
in  histories  of  urnings  and  other  sexual  perverts,  167 ;  conclusions, 
190. 

CHAPTER   X. 

DIAGNOSIS  AND  PROGNOSIS, 192-196 

Remarks  on  perverse  activity,  original  disposition,  accessory  causes, 
and  neuropathic  and  psychopathic  symptoms,  192;  dependence  of 
prognosis  upon  the  causes  of  origin,  195. 

CHAPTER  XL 

PSYCHICAL  AND  SUGGESTIVE  TREATMENT  OF  SEXUAL  PERVERSION,    197-209 

Consciousness  of  moral  duty  as  a  prophylactic,  with  remarks  on 
education  in  morals,  from  the  stand -point  of  the  theory  of  sugges- 
tion, 197  ;  other  mean's  for  the  prevention  of  sexual  errors,  202 ; 
should  urnings  be  treated  ?  203  ;  marriage,  203  ;  onanism  and  ex- 
citing causes,  204  ;  psycho-therapeutics  in  cases  of  perverse  instinct, 
205  ;  regulated  sexual  intercourse,  206  •  suggestive  treatment  in 
hypnosis,  208. 

CHAPTER   XII. 

HISTORIES  ILLUSTRATING  SUGGESTIVE  THERAPEUTICS  IN  PERVERSIONS 

OF  THE  SEXUAL  INSTINCT, 210-305 

Psycho-sexual  hermaphroditism,  Cases  39  to  45,  210  ;  contrary  sexual 
instinct,  Cases  46  to  59,  217;  algolagny,  Cases  60  and  61,  230;  con- 
trary sexual  instinct,  Cases  62  to  67,  232  ;  algolagny,  Cases  68  to  70, 
291 ;  tabular  review,  303  ;  conclusions,  302. 


APPENDIX, 307-319 


I.  SEXUAL  HYPER^ESTHESIA. 


CHAPTER   I. 

PATHOLOGY. 

THE  great  importance  of  premature  excitation  of  sexual 
feelings,  with  the  masturbation  usually  accompanying  it,  in  the 
production  of  psycho- .sexual  abnormalities,  justifies  an  exami- 
nation here  of  its  causes  and  their  nature.  In  his  classification 
of  the  cerebrally  conditioned  sexual  neuroses,  von  Krafft-Ebing 
correctly  differentiates  sexual  instinct  arising  in  childhood  and 
sexual  desire  re-awakened  in  old  age  (paradoxia)  from  abnormal 
intensification  of  it  (hypersesthesia *).  In  a  study  of  onanism 
from  a  therapeutic  stand-point,  based  upon  histories  of  patients, 
it  is  difficult  to  carry  out  this  principle.  According  to  von 
Krafft-Ebing,  we  have  to  do  with  actual  paradoxia  in  a  child 
only  when  sexual  feelings  and  impulses  occur  as  a  result  of 
cerebral  processes,  but  not,  by  any  means,  in  the  numerous  cases 
where  peripheral  causes  (phimosis,  balanitis,  oxyuris,  etc.)  in- 
duce manipulation  of  the  genitals.  This  etiological  distinction 
cannot  always  be  made  in  cases  of  onanism ;  and  it  cannot  be 
denied  that  an  original  peripheral  stimulus  is  capable  of  in- 
ducing the  same  symptoms  of  psycho-sexual  abnormality  as 
those  resulting  from  a  purely  central  cause,  and,  in  a  measure, 
may  become  the  exciting  cause  of  the  premature  appearance 
of  sexual  desire.  On  the  contrary,  in  almost  all  cases  an  ab- 
normally intense  sexual  desire  is  the  result  of  masturbation 
in  childhood;  a  desire  which  is  scarcely  ever  satiated  within 
the  limits  of  that  indulgence  which  is  usually  sufficient  with 
relatively  frequent  repetition  of  intercourse. 

The  individual,  at  first  suffering  with  "  paradoxia,"  is  soon 
affected  with  "  hypersesthesia  of  the  sexual  instinct."  But,  also 

1  Comp.  von  Krafft-Ebing,  "  Psychopathia  Sexualis,"  Chaddock's  translation  (F.  A. 
Davis  Co.,  Phila.,  1893),  pp.  48,  51-55. 

(i) 


2  SEXUAL     HYPERAESTHESIA. 

in  so  far  as  onanism  in  itself  presumes  an  unconquerable  im- 
pulse, and  incapability  to  control  it,  it  may  be  classified  as 
hyperaesthesia  sexualis. 

In  spite  of  full  recognition  of  the  theoretical  and  clinical 
importance  of  von  Krafft-Ebing's  classification,  practical  con- 
siderations in  the  main  have  induced  me  to  unite  the  cases  at 
my  command  under  the  title  of  "  Sexual  Hyperaesthesia,"  and, 
for  the  sake  of  clearness,  to  divide  them  into  two  classes : — 

1.  Onanism  (auto-sexual  indulgence). 

2.  Satyriasis  and  nymphomania  (heterosexual  indulgence). 
Upon  the  opinions  we  entertain  of  the  nature  of  these 

pathological  conditions  depend  the  therapeutic  measures.  Only 
an  exact  study  of  the  various  forms  of  manifestation  in  which 
hypercesthesia  sexualis  may  appear,  as  well  as  a  correct  ap- 
preciation of  other  methods  of  treatment,  can  make  clear  the 
indications  for  the  application  of  therapeutic  suggestion. 

A.  ONANISM. 

The  most  common  method  of  abnormal  satisfaction  of 
sexual  desire  is  onanism  (derived  from  the  word  Onan ;  comp. 
Genesis,  xxxvi,  9).  By  this  term,  in  its  widest  sense,  are 
understood  all  means  used  by  either  sex  to  induce  the  sexual 
orgasm  outside  of  the  conditions  of  normal  sexual  intercourse.1 

According  to  this  definition,  even  those  acts  which  in 
nowise  resemble  coitus,  but  which  are  practiced  by  one  person 
on  another  for  the  artificial  induction  of  the  sexual  orgasm,  are 
to  be  regarded  as  onanistic,  no  matter  whether  the  persons  be 
of  the  same  or  of  opposite  sex.  Therefore,  coitus  in  os,  coitus 
inter  mammae,  mutual  masturbation,  etc.,  may  be  designated 
as  onanistic  acts  performed  by  means  of  the  body  of  another 
person. 

These  perverse  manifestations, — i.e.,  those  wanting  the 
purpose  of  procreation, — when  practiced  inordinately  or  homo- 
sexually,  are,  as  a  rule,  to  be  regarded  as  symptoms  of  forms  of 

psycho-sexual  disease -which  we  shall  consider  in  later  chapters. 

• 

1  Comp.  Christian  (Charenton),  Extr.  du  Hist,  encyclop.  des  scienc.  m6dic. ;  and 
Centralb.  fur  Nervenheilk.,  von  Erlenmeyer,  1882. 


ONANISM.  3 

In  a  narrower  sense,  we  understand  by  onanism  those  acts 
which  an  individual  carries  out  on  himself  in  order  to  induce 
the  sexual  orgasm.  Only  this  manner  of  sexual  indulgence, 
which  is  the  most  common,  will  occupy  us  here. 

Causes  and  Predisposition. — The  occasion  for  handling  the 
genitals  frequently  arises  in  connection  with  irritation  of  them 
in  childhood  (eczema,  pruritus,  phimosis  with  consequent  ac- 
cumulation of  smegma).  Besides  this  source  of  masturbation, 
which  is,  to  a  certain  extent,  involuntary,  there  are  movements, 
made  for  other  purposes,  which  may  accidentally  lead  to  mas- 
turbation,— for  example,  gymnastics,  running  sewing-machines,1 
etc.,  while  wearing  too  close-fitting  clothing.  In  such  cases, 
therefore,  the  participation  of  the  fancy  in  the  lustful  feeling  is 
secondary  and  concomitant.  In  fact,  excessive  auto-mastur- 
bation may  exist  for  years  with  perfect  purity  of  the  child's 
imagination;  indeed,  with  complete  ignorance  of  the  sexual 
relations.  In  one  of  the  cases  treated  by  me  onanism  had  been 
practiced  for  eight  years,  and  the  patient  had  never  had  any 
impure  fancy  in  connection  with  it ;  she  could  not  have  had, 
owing  to  her  absolute  ignorance  of  the  sexual  relations.  It 
seems  to  me  that,  in  the  numerous  publications  on  this  subject, 
the  significance  of  this  point  has  not  received  due  consideration. 
And  yet  the  associations  which  become  connected  with  the 
onanistic  act  are  of  fundamental  importance  in  the  etiology  and 
development  of  the  special  form  of  the  resulting  psycho-sexual 
abnormality. 

More  frequently  than  the  accidental  influences  affecting 
the  genitals  that  have  been  mentioned,  seduction,  bad  example, 
etc.,  occasion  the  development  of  the  vice,  especially  in  schools, 
in  boys'  and  girls'  academies,  and  in  prisons  and  houses  of  cor- 
rection. Almost  an  invariable  accompaniment  of  masturbation 
thus  acquired  is  the  implication  of  the  imagination  through 
pictures  having  a  sexual  and  obscene  content.  Often,  too,  in 
the  family  itself  the  cause  lies  in  nurses,  servant-maids,  and 
servants  who,  either  for  their  own  pleasure  or  to  quiet  the 

1  Comp.  Fournier,  De  1'onanisme.    4th  ed.    Paris,  1885,  p.  67. 


4  SEXUAL     HTPER^STHESIA. 

crying  children,  manipulate  their  genitals.1  It  is  also  clear  that 
certain  subjects  taught  turn  the  attention  of  pupils  to  sexual 
matters,  and  thus  give  childish  fancy  an  evil  direction.  It  is 
only  necessary  to  recall  certain  passages  in  Greek  and  Roman 
classics,  and  certain  chapters  in  the  Bible  that  are  not  to  be 
misunderstood. 

Gyurkovechky2  is  of  the  opinion  that  idleness  of  pupils 
during  play-hours,  spicy  food,  and  exciting  drinks,  as  well  as 
early  retiring  and  late  rising,  are  to  be  regarded  as  predisposing 
causes  of  inordinate  onanism.  Even  though  it  cannot  be  denied 
that  any  of  these  circumstances  may  give  an  onanist  welcome 
opportunity  to  indulge  excessively  in  his  vice,  it  is  difficult  to 
understand  how  such  influences  could  lead  a  pure  child  to 
masturbation.  Indeed,  in  all  cases  it  requires  some  other  ex- 
traneous influence  to  lead  the  child  to  the  first  indulgence  in 
the  pernicious  habit. 

Too,  even  in  individuals  untainted  hereditarily,  continued 
onanistic  irritation  of  the  central  nervous  system  is  capable 
of  inducing  a  neuropathic  constitution,  and,  in  consequence, 
numerous  maladies.  Moreover,  continued  or  temporary  absti- 
nence from  sexual  intercourse,  after  the  occurrence  of  sexual 
maturity,  predisposes  to  the  development  of  .neurasthenia  and 
sexual  hyperexcitability,  at  least  in  many  untainted  individuals, 
who  then  resort  to  auto-masturbation  faute  de  mieux.  In  the 
majority  of  cases  which  come  for  medical  treatment,  however, 
the  individuals  are  of  tainted  heredity. 

Lombroso3  examined  11  onanists,  and  found:  without 
physical  anomalies,  3 ;  with  physical  anomalies,  8 ;  parents 
normal,  3 ;  unknown,  1 ;  abnormal,  7. 

In  cases  of  neuropathic  predisposition  onanism  frequently 
becomes  the  exciting  cause  of  the  malady,  while,  according  to 
von  Krafft-EbingV  experience,  which  is  no  less  extensive,  in 
untainted  individuals  the  limits  of  an  asthenic  neuropsychosis 

1  Comp.   Gyurkovechky,  Path,   und  Theraple  der  Maiml.  Impotenz,  Urban  und 
Schwarzenberg.    Wien,  1889,  p.  106. 
9  Loc.  c«.,p.  108. 

1  Lombroeo,  Der  Verbrecher,  Hamburg,  1887,  p.  128. 
4  Von  Krafft-Ebing,  Psychiatric,  3  aufl.    Stuttgart,  p.  308. 


ONANISM.  5 

are  scarcely  ever  passed  as  a  result  of  onanistic  excesses.  To 
be  sure,  the  addition  of  some  other  exciting  cause  may,  on  the 
basis  of  the  acquired  neuropathic  condition,  give  rise  to  any 
form  of  insanity.  But  there  are  also  cases  in  which  onanism  is 
to  be  regarded  as  an  immediate  symptom  of  the  neuropathic 
state  or  psychosis ;  for  example,  in  maniacal  states  with  sexual 
excitement,  as  they  occur  in  hysteria  and  epilepsy,  and  as  the 
forerunners  of  mania  and  paretic  dementia.1  In  his  classification 
based  upon  anatomical  principles,  Magnan  classifies  a  certain 
form  of  onanism  as  belonging  to  the  "spinal"  sexual  anomalies, 
and  speaks  of  automatism  of  the  genital  reflex  centre.  He 
mentions  a  female  idiot,  aged  7,  who  masturbated  continuously 
after  her  third  year,  and  who  could  not  be  kept  from  it  by  any 
means.  Magnan  believes  that  the  girl  masturbated  as  a  result 
of  irritation  seated  in  the  genito-spinal  centre ;  for  all  sensorial 
cerebral  functions  were  to  be  regarded  as  absent.2  Here  it  may 
be  advantageous  to  review  the  anomalies  of  the  sexual  instinct 
in  imbeciles  and  idiots.  In  relation  to  the  symptoms  of  par- 
adoxical expression  of  the  sexual  appetite, — sexual  hyperaBS- 
thesia  in  general, — according  to  the  statements  of  Sollier3  and 
Bourneville,4  onanism  is  of  the  greatest  importance.  The  author 
first  named  expresses  himself  as  follows  : — 

"  In  uncleanly  and  incurable  idiots  there  can  be  no  thought 
of  a  real  sexual  instinct;  the  onanism  which  most  of  them 
practice  cannot  be  regarded  as  its  expression.  In  idiots  capable 
of  education  sexual  instinct  may  make  itself  noticeable,  but  it  is 
always  weak.  Sometimes  it  is  abnormally  developed  and  per- 
verse, but  never  normal.  On  the  other  hand,  imbeciles  are 
often  prematurely  developed,  and,  at  the  same  time,  they  mani- 
fest most  of  the  sexual  perversions." 

The  most  frequent  and  earliest  aberration  of  the  sexual 
instinct  is,  according  to  Sollier,  onanism.  Some  masturbate 

1  Magnan,  "  Des  anomalies,  des  aberrations,  et  des  perversions  sexuelles,"  Progres 
M6dical,  1885. 

a  Comp.  von  Krafft-Eblng,  "  Ueber  Irresein  durch  Onanie  bei  Mannern,"  Allgem. 
Zeitschrift  fur  Psychiatric,  1874,  p.  425. 

1  Paul  Sollier,  Der  Idiot  und  der  Imbecilles,  Leipzig,  1891,  p.  75  et  seq. 

*  Bourneville  and  Sollier,  "  Des  anomalies  des  organs  g6nitaux  chez  les  idiots  et  lea 
epileptiques,"  Progres  M6dical,  1887. 


6  SEXUAL     HYPER^ESTHESIA. 

automatically ;  others  know  what  they  do,  and  seek  in  the  prac- 
tice sexual  gratification.  Idiots  of  two  or  three  years,  who 
masturbate  constantly,  so  to  speak,  belong  to  the  first  category. 
"  With  them  it  is  a  tic  similar  to  others  they  present.  That 
sexual  desire  has  nothing  to  do  with  it  is  clear.  Often  there 
are  seen  malformations  that  are  in  nowise  related  to  the  sexual 
instinct.  On  the  other  hand,  I  have  previously  called  attention 
to  the  fact  that  certain  idiots  experience  pleasant  sensations 
with  their  tics" 

Automatic  masturbation  occurs  at  a  certain  age  in  idiotic 
demenj;s.  It  is  also  found  in  very  young  idiots  and  imbeciles, 
as  sometimes  in  normal  children.  In  the  latter  the  habit  is 
abandoned  with  increasing  years,  especially  with  the  occurrence 
of  puberty  and  as  a  result  of  education.  Even  though  idiotic 
children  find  a  certain  sexual  satisfaction  in  the  practice,  it  is 
not  to  be  regarded  as  true  sexual  pleasure.  Usually  real 
sexual  pleasure  is  to  be  observed  only  after  the  genitals  have 
reached  their  full  development  at  puberty.  In  many  in- 
stances, however,  true  sexual  instinct  is  developed  remarkably 
early.  Sollier  saw  several  idiots  of  very  low  intelligence,  who, 
from  the  fourth  or  fifth  year,  found  pleasure  in  touching  little 
girls  or  women.  Many  sought  to  violate  their  little  sisters  and 
touch  them  indecently ;  others  approached  their  mothers  by 
lifting  their  skirts.  "  Often  in  asylums  for  idiots  they  are  seen 
to  attempt  indecent  fondling  of  their  nurses,  and  they  like  to 
come  in  contact  with  them,  thus  being  thrown  into  a  state  of 
general  excitement.  These  inclinations  are  observed  toward 
women  and  girls  more  frequently  than  toward  children  of  the 
same  sex.  This  seems  to  demonstrate  that  the  inclination  is  a 
true  sexual  instinct.  But  in  normal  children  sexual  excitation 
occurs  more  frequently,  and  that  before  puberty,  than  is  sus- 
pected." 

In  imbeciles  onanism  is  less  frequent  up  to  puberty  than 
in  idiots;  but  after  that  period  the  relation  is  reversed.  After 
puberty  onanism  occurs  under  the  influence  of  the  sexual  in- 
stinct for  sexual  gratification.  In  this  respect  the  girl  is  like 
the  boy.  Sollier  reports:  "A^girl  in  Bicetre  masturbated  by 


ONANISM.  7 

rubbing  the  thighs  together  (the  most  common  method),  and 
thus  finally  induced  an  erythema  of  both  thighs.  In  spite  of 
this  condition  she  continued  the  practice  so  long  that  the  skin 
became  gangrenous,  and  the  surface  of  the  sores  could  never 
be  entirely  healed." 

According  to  the  later  psychiatric  investigations  (Christian, 
Kraepelin,  Forel,  Vogel,  Lowenfeld,  UfFelmann,  von  Krafft- 
Ebing,  etc.1)  it  is  put  beyond  doubt  that  habitual  masturbation 
is  either  a  concomitant  symptom  of  an  existent  neuropathic 
condition,  or,  as  a  rule,  induces,  in  connection  with  inherited  or 
acquired  predisposition,  pronounced  disturbances  of  the  nervous 
system. 

Forms  of  Onanism, — The  induction  of  sexual  orgasm  in 
onanists  is  either  by  means  of  peripheral  or  central  irritation, 
or  both  simultaneously.  From  a  practical  stand-point,  three 
groups  may  be  distinguished:.  1.  Onanism  by  means  of  tactile 
excitation.  2.  Onanism  by  means  of  psychical  excitation.  3. 
Onanism  by  means  of  a  combination  of  sensory  and  ideational 
excitation. 

1.  Onanism  by  Means  of  Tactile  Excitation  (Masturbation, 
Manustupration).—^W\n\e  in  the  first  group  the  implication  of 
the  imagination  takes  place  as  a  secondary  accompaniment,  in 
the  second  group  it  is  the  principal  means  of  gratification. 
Merely  friction  of  the  glans,  rubbing  of  the  clitoris,  or  other 
tactile  irritation  of  erogenous  areas  (in  women :  vagina,  cer- 
vix uteri,  nipples,  and,  under  pathological  conditions,  places  in 
the  proximity  of  the  genitals  and  mammae ;  in  men :  the  skin 
of  the  external  genitals,  and,  according  to  some  authors,  under 
pathological  conditions,  the  anus),  according  to  Hammond's2 
opinion,  is  not  sufficient  to  induce  the  necessary  degree  of 
sensual  excitation;  rather,  the  peripheral  stimulus  induces  ideas 

1  Christian, Onanisme  (Extr.  du  diction,  encyclop.  des  sciences  m6dicales)  ;  reference 
in  Erlenmeyer's  Centralbl.  fur  Nervenheilkuude,  1882,  p.  198.  Kraepelin,  Lehrbuch  der 
Psychiatric,  p.  32.  Forel,  "  Einige  Worte  iiber  die  reglementirte  Prostitution  in  Kiew  und 
fiber  sexuelle  Hygiene,"  Separatabdruck  ausdem  Correspondenzblatt  fur  Schweizer  Aerzte, 
1889.  Vogel,  Lehrbuch  fur  Kinderkrankheiten,  5  aufl.,  p.  387.  Uffelmann,  Handbuch 
der  offentl.  und  privaten  Hygiene  des  Kindes,  1881,  p.  368.  Lowenfeld,  Die  nervosen  Stor- 
angen  sexuellen  Ursprungs,  Wiesbaden,  1891,  pp.  64,  65. 

9  Hammond,  Sexual  Impotence. 


8  SEXUAL     HYPER^ESTHESIA. 

with  which  pleasurable  feelings  become  associated.  The  con- 
tent of  these  ideas  is,  in  the  majority  of  instances,  concerned 
with  sexual  relations  and  situations.  The  most  common  method 
of  tactile  stimulation  of  the  genitals  consists  of  rubbing,  press- 
ing, swinging  movements  of  the  thighs,  or  of  fondling  and 
friction  with  the  hands.  Females1  make  use  of  the  most  vari- 
ous objects  for  masturbation;2  they  insert  large  and  small  objects 
into  the  vagina,  such  as  hairpins,  crochet-hooks,  needle-cases, 
lead-pencils,  radishes,  spools,  and  candles.  "  Married  women," 
according  to  Winckel,3  "  choose  fir-twigs,  artificial  penes  made 
of  bacon,  and  even  pomade-jars  and  drinking-glasses.  The 
most  ludicrous  combination  of  this  kind  that  has  ever  been  dis- 
covered was  found  by  K.  Schroder, — a  pomade-jar  and  a  cricket 
in  the  vagina."  These  objects,  which  easily  slip  from  the  hand, 
often  give  occasion  for  operative  interference.  One  of  my  pa- 
tients rubbed  the  clitoris  with  a  sponge.  Too,  the  ideas  which 
accompany  the  manipulations  sometimes  concern  strange  objects. 
Thus,  one  of  my  patients  who  masturbated  thirty  years,  and 
lived  for  the  most  part  in  the  country,  conceived  that  she  was 
in  coitus  with  a  stallion. 

Here  but  brief  allusion  can  be  made  to  Ehe  anthropological 
significance4  of  masturbation.  Among  the  Khoikhoin  (Nama 
Hottentots),  according  to  Ploss,5  in  the  youths  of  the  female 
sex  masturbation  is  so  frequent  that  the  practice  might  be  re- 
garded as  a  custom.  Therefore,  no  especial  secret  is  made  of 
the  matter,  and  in  their  tales  and  folk-lore  the  people  speak 
of  it  as  of  a  customary  matter  (Fritsch0). 

The  vice,  even  at  the  time  of  the  arrival  of  the  Spaniards, 
was  wide-spread  among  the  females  of  the  Philippines ;  they  had 
invented  an  artificial  penis  with  which  to  gratify  their  insatiable 

1  Pouillet,  De  1'Onanisme  de  la  femme.    3d  cd.     Paris,  1877. 

3  De  Giovanni,  Di  una  causa  posa  valutata  nella  patogenesi  di  alcune  infirm!  ta  mull- 
ebri  (Gazz.  Mod.  Lombarda,  1877,  No.  15,  p.  141). 

1  Comp.  Wlnckcl,  Diseases  of  Women. 

4  According  to  Mantegazza  (Hygiene  der  Liebe,  p.  83),  the  English  physician,  Cope- 
land,  has  stated  :    "  The  Jews  owe  their  great  power  of  resisting  many  epidemic  diseases 
and  a  certain  mental  deliberation  to  the  fact  that  masturbation  is  unknown  among  them." 
That  this  statement  is  erroneous  is  shown  by  the  experience  of  Mantegazza  and  others. 

'  Ploss,  Das  Weib,  Leipzig,  1891,  Bd.  1,  p.  330. 

•  Fritsch,  Die  Eingeboren  Siidafrikas,  Breslau,  1873,  pp.  Ill,  380. 


ONANISM.  9 

desires,  and  they  had  other  similar  means  for  the  satisfaction  of 
their  unnatural  lust  (Blumentritt1). 

Manipulations  which  cause  enlargement  of  the  clitoris  and 
labia  minora,  it  seems,  are  indulged  in  either  purposelessly  (at 
least,  not  in  conscious  action)  or  for  various  purposes.  Accord- 
ing to  Floss,2  among  many  barbarous  peoples  the  indulgence  of 
the  youthful  females  in  masturbation,  pleasurable  titillation,  and 
lustful  pinching  and  pulling  of  the  excitable  portions  of  the 
genitals,  is  the  cause  of  their  gradual  change  of  form.  Still, 
perhaps  these  practices  are  undertaken  with  the  more  or  less 
clearly-conscious  purpose,  not  only  of  increasing  the  individual's 
own  lustful  pleasure,  but  also  with  a  view  to  so  change  the 
genitals  as  to  better  adapt  them  for  the  performance  of  tri- 
badism, — a  vice  which  has  always  been  very  wide-spread  in  the 
Orient. 

2.  Onanism  by  Means  of  Psychical  Stimuli  (Psychical 
Onanism}. — Central  excitation  of  the  sexual  orgasm,  as  by 
simple  memory-pictures,  is  always  a  sign  of  psycho-sexual 
hypersesthesia,  and  is  to  be  regarded  as  occurring,  for  the  most 
part,  as  a  manifestation  of  cases  falling  in  group  1 ;  for  example, 
in  hysterical  individuals,  those  tainted  hereditarily,  and  in  states 
of  psychical  exaltation.  According  to  von  Krafft-Ebing,3  where 
this  means  is  effectual  the  fancy  is  abnormally  excitable,  and 
associations  are  facilitated. 

The  pollutions  which  take  place  in  both  sexes  as  a  result 
of  erotic  thoughts,  both  in  dreams  and  the  waking  state,  must 
be  placed  in  this  class ;  the  sensual  excitation  is  brought  about 
purely  by  an  act  of  the  imagination.  Thus,  for  example,  a 
man  concentrates  his  entire  attention  in  thought  upon  a  female ; 
"fancies  that  he  approaches  her  vulva  and  attempts  immissio 
penis ;  then  he  thinks  of  the  various  stages  of  coitus,  until 
finally  he  experiences  the  complete  orgasm."4 

According  to  Hammond,  there  are  men  who  know  only 

1  Blumentritt,  "  Der  Ahnencultus  und  die  religiosen  Auschauungen  des  Philippinen 
archipels,"  Mitth.  d.  12, 12  geog.  Gesellsch.  in  Wien,  1885,  xxviii,  2. 
9  Ploss,  Das  Weib,  Leipzig,  1891,  Bd.  i,  p.  330. 
1  Von  Kraflt-Ebing,  Psychopathia  Sexualis,  p.  39. 
*  Hammond,  Sexual  Impotence. 


10  SEXUAL     HYPERJESTHESIA. 

this  kind  of  excitation,  and  who  have  no  erection  in  the  normal 
way.  As  a  rule,  this  hypersesthesia  occurs  after  masturbatic  or 
other  sexual  excesses ;  so  that  the  matter  is  one  of  memory- 
pictures  in  different  variations.  One  of  my  patients  is  also  able 
to  indulge  in  the  pleasure  of  this  ideal  coitus  at  any  time.  A 
quiet,  comfortable  position,  either  lying  or  sitting,  is  the  pre- 
paratory measure  necessary  for  success.  Then  he  allows  His 
fancy  free  rein,  and  dreams  intensely — though  consciousness  is 
intact — that  he  is  in  the  desired  situation,  until  ejaculation  takes 
place.  This  calls  to  mind  the  artificial  induction  of  dreams  by 
narcotics.  In  "  The  Significance  of  Narcotics  in  Hypnotism  " 1 
I  have  shown  that  narcotics  (alcohol,  opium,  etc.),  especially 
Indian  hemp,  induce  a  condition  favorable  for  the  acceptance 
of  suggestions, — even  for  auto-suggestions  ;  hence  the  use  of 
haschish  by  Orientals  when  they  wish  to  give  themselves  up 
entirely  to  a  drunken  imagination  in  which  ideas  of  a  sexual 
character  play  the  principal  role. 

Too,  such  pollutions  in  the  female  sex,  which  are  most 
frequently  induced  in  sleep  by  erotic  dreams,  are  not  without 
importance.  At  the  height  of  sexual  excitement  an  abundant 
secretion  is  emptied  from  the  glands  of  Bartholini.  In  many 
women,  as  Robinson2  states,  a  lustful,  convulsive  sensation, 
which  is  also  painful,  occurs,  which  Robinson  attributes  to  con- 
traction of  the  constrictor  cunni.  In  his  opinion,  previous 
masturbation  and  regular  coitus  are  to  be  regarded  as  the  etio- 
logical  factors.  Many  of  these  patients  experience  a  subsequent 
feeling  of  relief,  and  the  next  morning  are  refreshed ;  many 
others  awake  with  pain  in  the  back  after  pollution. 

The  induction  of  orgasm  by  erotic  ideas  is  of  especial 
interest  by  reason  of  the  religious  significance  that  has  been 
given  it  in  the  imagination  of  ignorant  peoples.  "  There  is  an 
uncommonly  wide-spread  belief  that  evil  spirits  of  a  certain  kind 
possess  the  power  to  visit  young  maidens  and  wives,  and  also 
youths  and  husbands,  while  in  bed  at  night,  of  course  always  in 

1  Schriften  der  GesellschafTt  fur  Psycliologische  Forschung  (Leipzig,  Abel,  1891), 
Heft  1. 

0  Robinson,  "Klin.  Beob.  iiber  Pollutionen  beim  Weibl.  Gescblecht,"  Med.  Ag., 
1889,  No.  7. 


ONANISM.  11 

the  seductive  form  of  the  opposite  sex,  in  order  to  perform  coitus 
with  them.1  The  feeling  of  depression  on  the  day  following  the 
pollutions  is  ascribed  to  the  power  of  the  evil  spirit  of  the  night 
to  sap  the  strength.  These  demons,  which  during  the  middle 
ages  were  known  as  incubus  and  succubus,  as  ephiaUes  and 
hypliialtes,  as  night-power  or  weight,  as  night-mare,  etc.,  were 
known  to  the  civilized  peoples  of  Western  Asia  many  centuries 
before  the  beginning  of  our  historical  reckoning,  and  they  were 
feared  under  the  names  of  night-men  and  night-women."  Ac- 
cording to  Floss,  in  the  ruins  of  Ninevah  were  -found  a  great 
number  of  tablets  of  terra-cotta  from  the  library  of  Assurbanip- 
alus  (Sardanapalus  of  the  Bible)  on  which  there  were  cuneiform 
inscriptions.  Among  them  were  formulae  for  exorcism  and 
prayers  in  Accadian  characters,  with  an  Assyrian  translation 
inscribed  above  them,  which  were  directed  against  the  night- 
men  (lillal)  and  the  night-women  (kiel-lillal).  We  are  justified 
in  assuming  that  there  was  a  belief  in  the  possibility  of  cohabi- 
tation with  a  god,  where  we  find  that  mature  maidens  who 
were  approaching  marriage  sacrificed  their  maidenhood  in  the 
temple  as  a  custom.  Legendary  demoniacal  animals  are  also 
frequently  held  to  be  the  progenitors  of  whole  tribes,  especially 
among  the  Indians  and  Polynesians.  The  consorting  with  the 
devil  for  years,  which  comes  to  us  from  the  fourteenth  and 
fifteenth  centuries,  is  well  known.  Usually  this  sexual  congress 
took  place  at  night ;  but  women  were  even  "  found  in  broad 
daylight  in  the  fields  entirely  naked,  and  sometimes  their 
husbands  found  them  in  the  embrace  of  the  devil,"  etc. 

The  forest  has  always  been  regarded  as  the  place  of  prefer- 
ence for  the  attacks  of  demons  upon  women.  The  lust  of 
satyrs,  fauns,  and  sylvans  is  well  known;  and  the  Druids  of  the 
ancient  Gauls  and  the  forest-god  of  the  Germans  may  be 
recalled. 

In  the  islands  of  Aaro  the  unchaste  forest-god  has  power 
only  over  menstruating  women,  who,  therefore,  dare  not  enter  a 
forest.  The  states  of  excitement  in  the  genital  apparatus  at  the 
time  of  puberty  in  both  sexes,  and  at  the  time  of  menstruation 

1  Ploes,  Das  Weib,  Leipzig,  1891,  Bd.  i,  p.  332. 


12  SEXUAL     HYPEILESTHESIA. 

in  maidens  and  women,  have  a  reflex  effect  upon  the  central 
nervous  system,  and  induce  erotic  ideas  that  may  attain  the 
intensity  of  hallucinations,  which  then  correspond  with  the  re- 
ligious belief  of  the  individuals.  The  centrifugal  effect  of  such 
ideas  is  to  induce,  either  in  the  sleeping  or  waking  state,  should 
they  be  intense  enough,  the  well-known  lustful  feelings ;  and 
this  differs  from  voluntary  psychical  onanism  only  in  the  uncon- 
scious and  latent  excitation  of  the  imagination.  Essentially, 
however,  in  both  cases  it  is  ideal  cohabitation, — the  induction 
of  orgasm  by  sexual  ideas  which  on  their  part  are  conditioned 
by  organic  or  psychical  causes,  and  which,  therefore,  are  physical 
in  any  case. 

3.  Onanism  by  Means  of  a  Combination  of  Sensory  and 
Ideational  Excitation. — In  orianists  of  the  third  group  the  im- 
agination alone  is  inadequate  for  the  induction  of  sexual  orgasm. 
On  the  contrary,  the  imagination  must  be  intensely  excited  by 
a  sensory  impression  in  order  to  induce  a  sufficient  degree  of 
sensual  excitement  in  the  nervous  system.  Often  sensory  im- 
pressions that  appear  to  have  no  relation  to  the  sexual  life 
(optical  and  tactile  impressions,  odors,  and  tastes)  are  sufficient 
to  excite  the  psycho-sexual  mechanism.  That,  as  von  Krafft- 
Ebing1  thinks,  in  all  cases  lascivious  ideas  are  induced,  according 
to  my  experience,  seems  questionable.  With  hyperexcitation  of 
the  genital  centres,  ejaculation  occurs  without  other  tactile  irri- 
tation of  the  sexual  organs,  as  in  psychical  onanists.  In  other 
cases  ideas  alone  are  not  sufficient  to  induce  the  orgasm,  which 
takes  place  only  with  mechanical  assistance  (masturbation,  press- 
ing and  rubbing  of  the  thighs). 

Too,  in  some  individuals  a  variation  is  to  be  noticed,  in  that 
with  extraordinary  excitation  the  imagination  is  sufficient  to 
conclude  the  act,  while  in  other  cases  manipulations  complete 
the  work.  Thus,  one  of  my  patients  reports  that  when  he  was 
18  he  excited  himself  sexually  by  looking  at  obscene  photo- 
graphs; on  one  occasion  only  did  the  excitement  become  so 
intense  as  to  cause  spontaneous  ejaculation,  and  then  it  was  with 
a  feeling  of  lustful  pleasure  such  as  he  had  never  before  experi- 

1  Von  Krafft-Ebing,  Psychopathia  Sexualis. 


ONANISM.  13 

enced.  Another  patient,  who  is  at  the  same  time  of  contrary 
sexuality,  has  erection  only  when  he  sees  naked  male  nates. 
The  idea  of  the  nates  is  not  sufficient,  at  least,  in  the  waking 
state,  though  it  is  efficient  in  dreams.  Two  female  onanists, 
seen  in  my  practice,  without  any  friction  induced  sexual  orgasm 
by  sensory  impressions  which  had  no  sexual  relation  whatever. 
One  practiced  onanism  in  this  way  while  hearing  music,  or  while 
regarding  landscape  paintings,  and  that  without  anything  like  a 
lascivious  idea.  The  other  was  sensually  excited  at  the  sight 
of  the  grandeurs  of  nature,  such  as  the  sea.  Both  patients 
indulged  in  onanism  in  the  street,  in  cafes,  in  the  theatre,  and 
in  street-cars,  without  in  any  way  attracting  the  notice  of 
those  about  them.  While  with  the  first  there  was  no  knowl- 
edge of  sexual  intercourse,  with  the  second  occurred  ideas  of 
a  sexual  nature.  When  she  became  attracted  by  the  sight 
of  an  especially  strong  and  handsome  male  form,  orgasm  would 
occur  in  one  minute  at  most.  The  touch  of  the  physician  in 
the  first  examination  induced  it.  Another  patient  is  able  to 
have  ideal  cohabitation  at  a  distance.  For  example,  he  seats 
himself  in  the  theatre  vis  d,  vis  a  lady  attractive  to  him ;  then 
he  allows  his  fancy  free  rein,  and  thus  enjoys  the  pleasures  of 
love  by  picturing  so  intensely  to  himself  all  the  positions  of 
coitus  with  the  person  that  ejaculation  results. 

According  to  Hammond,1  it  seems  that  in  America  such 
persons  form  a  kind  of  a  union  or  society,  and  have  certain  signs 
by  which  they  recognize  one  another.  They  call  themselves  by 
a  common  name,  which  signifies  "  a  man  who  indulges  in  ideal 
coitus."  They  say  that  they  can  tell  by  a  man's  face  whether  he 
belongs  to  their  society  or  not. 

One  of  my  patients,  of  contrary  sexuality,  had  an  ejacula- 
tion when  the  man  who  was  the  object  of  his  love,  and  who 
had  no  suspicion  of  the  condition  of  his  friend,  felt  his  pulse  on 
an  occasion  of  illness. 

In  another  case  of  contrary  sexuality  the  man  experienced 
orgasm  on  merely  shaking  hands  with  a  man  especially  attractive 
to  him. 

1  Comp.  Hammond,  loc.  cit. 


14  SEXUAL     HYPER^ESTHESIA. 

Hammond's  *  observation  in  the  case  of  an  epileptic  is  also 
remarkable :  "  He  took  employment  with  a  dealer  in  vegetables 
whom  he  liked  to  visit,  in  order  to  see  beautiful  women.  When 
he  had  chosen  his  partner,  he  would  concentrate  his  thoughts 
on  her  and  imagine  her  in  the  most  various  exciting  positions. 
It  was  not  difficult,  he  said,  to  fancy  her  before  his  eyes  entirely 
nude.  Then  he  would  make  voluntary  contractions  of  the 
glutei,  the  accelerator  urinae,  and  other  muscles,  and  usually 
after  no  longer  than  a  minute  orgasm  would  occur.  He  could 
also  induce  sexual  excitement  when  he  thought  of  a  lady  he 
had  just  seen,  without  having  her  before  his  eyes.  Natural 
sexual  intercourse,  on  the  other  hand,  afforded  him  no  pleasure ; 
on  the  contrary,  he  was  absolutely  impotent  with  women,  and 
not  even  with  the  help  of  fancy  was  he  able  to  have  sensual 
pleasure  in  coitus.  Finally  he  became  absolutely  unable  to 
prevent  the  excitement  which  came  on,  and  that  without  erec- 
tion, merely  at  the  sight  of  an  attractive  woman.  Likewise  a 
painting  or  wood-cut  of  a  woman,  dressed,  nude,  or  half-nude, 
induced  orgasm,  with  or  without  erection  and  ejaculation." 

In  the  cases  mentioned,  optical,  auditory,  and  tactile  per- 
ceptions (examples  of  olfactory  and  gustatory  impressions  acting 
in  this  way  are  not  known  to  me)  are  the  causal  factors  in  the 
excitation  of  the  sexual  sense,  and,  indeed,  regularly  with  devi- 
ation from  physiological  conditions,  and  often  without  any  rela- 
tion in  content  to  sexual  matters.  Many  authors  presume  a 
more  intimate  relation  between  the  olfactory  and  sensory  senses 
(von  Krafft-Ebing,2  Althaus,3  Cloquet4). 

In  his  latest  work,  Moll5  opposes  this.  In  his  opinion  the 
relationship  between  olfactory  impressions  and  the  sexual  in- 
stinct is  not  more  intimate  than  that  of  many  other  sensory  im- 
pressions, and  that  of  sight  with  the  sexual  sense  is  much  closer 
than  that  of  smell ;  especially  since  it  is  questionable  whether 
there  is  a  special  centre  for  sexual  sensations. 

1  Hammond,  loc.  cit. 

4  Von  Krafl't-Ebing,  PsycRopathia  Sexualis,  p.  26. 

1  Althaus,  "  Beitrage  zur  Physiol.  und  Pathol.  des  Olfactorius,"  Arch,  fur  Psych., 
xii,  H.  1. 

*  Cloquet,  Osphr6siologie,  Paris,  1826. 

1  Moll,  Die  contrare  Sexualempfindung,  Berlin,  1891,  pp.  188,  184. 


ONANISM.  15 

The  sensory  impressions  mentioned  induce  in  the  cerebral 
cortex  sexual  ideas,  feelings,  and  impulses  which,  in  hyperses- 
thetic  individuals,  may  give  rise  to  complete  sexual  satisfaction. 
When  it  is  present  in  sufficient  intensity,  a  memory-picture 
alone  may  have  the  same  effect.  While  in  this  chapter,  to  a 
certain  extent,  only  the  exterior  of  unphysiological  excitation 
and  abnormal  intensity  of  the  sexual  instinct  interest  us,  in 
Section  III  we  shall  learn  the  great  importance  which  is  to  be 
attributed  to  the  content  of  the  ideas  which  accompany  the  sexual 
excitement  in  giving  perverse  direction  to  the  vita  sexualis. 

Dangers  and  Results  of  Onanism^  with  Especial  Reference 
to  Insanity. — Though  onanism,  where  it  is  not  a  symptom  of 
a  psychopathic  or  neuropathic  predisposition,  may  always  be 
regarded  from  a  moral  stand-point  as  a  vice,  still  the  physician, 
as  a  rule,  will  be  concerned  only  with  such  cases  of  it  as  present 
more  or  less  profound  disturbance  of  the  nervous  system.  From 
a  more  humane  point  of  view,  this  "error,"  this  "sin  of  youth," 
is  to  be  looked  upon  as  a  malady,  as  a  disease  presenting  char- 
acteristic symptoms.  Concerning  the  real  cause  of  this  injuri- 
ous practice  authors  differ.  Thus,  Erb1  regards  the  single 
onanistic  act  as  no  more  harmful  than  that  of  normal  coitus. 
He  says:  "The  effect  upon  the  nervous  system  in  a  man  must 
be  essentially  the  same,  whether  the  friction  of  the  glans  takes 
place  in  the  vagina  or  is  otherwise  carried  out;  the  nervous 
shock  in  ejaculation  remains  the  same ;  it  might  well  be  pre- 
sumed that  the  nervous  excitement  would  be  greater  where  the 
female  is  used." 

But  in  reply  to  this  it  may  be  stated  that  masturbatic  acts, 
with  the  exception  of  such  infrequent  cases  as  those  of  Magnan,2 
which  must  be  regarded  as  instances  of  psychoses,  have  a  much 
more  intense  psychical  effect  than  does  coitus.  The  content  of 
the  ideas  in  every  single  onanistic  act  must  overcome  reality, 
and  thus  a  much  more  intense  strain  of  the  imagination  is 
necessary.  And  the  imagination  itself,  even  with  infrequent 
practice  of  onanism,  with  respect  to  the  accompanying  psycho- 

1  Erb,  Handbuch  der  RuckenmarkskrankLeiten,  p.  163. 
'  Comp.  p.  5. 


16  SEXUAL  HYPERyESTHESIA. 

sexual  product, — the  content  of  ideas, — becomes  artificially 
accustomed  to  a  single  direction  of  activity.  We  shall  learn  in 
Chapter  IX  the  deleterious  influence  of  the  content  of  the  ideas 
of  masturbators  in  cases  of  severe  psycho-sexual  disease.  Be- 
sides, the  fact  of  self-indulgence,  save  with  infrequent  perform- 
ance of  the  act,  brings  onanists  into  a  peculiar  and,  I  might 
say,  unphysiological  relation  to  the  opposite  sex.  In  that  it 
destroys  the  sexual  relation  with  the  opposite  sex,  it  weakens 
sexual  desire  and  attacks  the  most  powerful  natural  instinct — 
love's  impulse — at  its  very  root;  it  injures  the  whole  sexual 
foundation,  the  basis  of  all  ideal  activities ;  it  extinguishes  the 
fire  of  sensual  feeling,  the  most  powerful  incentive  to  the  putting 
forth  of  strength,  in  both  individual  and  social  existence,  in  the 
world  of  beauty  and  morality.1  Masturbation  moderately  prac- 
ticed exercises,  on  a  good  constitution,  no  direct  destroying 
effect,  but  it  changes,  when  it  is  long  indulged  in,  the  character, 
the  imagination,  and  the  whole  mental  existence  in  a  way  that 
is  unmistakable  and,  so  to  speak,  necessary.  These  evil  effects 
of  onanism  seem  to  us  to  be  greater  than  those  lesser  disturb- 
ances which  seldom  affect  materially  the  general  health,  and 
which  Dr.  Lowenfeld2  describes  in  detail. 

Still,  in  purely  a  physical  sense,  it  seems  questionable 
whether  coitus  and  masturbation  are  equivalent  acts.  Gyurko- 
vechky3  found  a  history  of  greater  depression  and  weariness 
after  occasional  indulgence  in  onanism  than  after  considerable 
excessive  coitus.  According  to  the  expression  of  many  patients, 
the  act  of  indulgence  which  leaves  behind  it  the  most  intense 
feeling  of  well-being  is  that  in  which  the  semen  is  expelled  with 
the  greatest  energy  and  strength.  Any  delay  in  the  expulsion, 
anything  like  weakness  or  lack  of  energy  in  the  completion  of 
the  act,  has  an  incomparably  weakening  effect  upon  the  nervous 
system.  But  Hammond4  assumes  that  the  sexual  act,  in  that  it 
requires  a  greater  expenditure  of  muscular  power,  must  certainly 
be  more  injurious  than  onanism  with  like  frequency  of  indulg- 

1  Comp.  von  Krafft-Ebing,  Psyc-hopathia  Sexualis,  p.  5. 

3  LSwenfeld,  "Die  nervosen  Storungen  sex.  Ursprungs,  pp.  89-94. 
1  Gyurkovechky,  Impotenz,  p.  103. 

4  Hammond,  loc.  cit. 


ONANISM.  17 

ence;  at  least,  with  reference  to  ejaculation  and  orgasm.  "  For, 
with  the  orgasm  and  the  loss  of  semen,  it  is  a  matter  of  indiffer- 
ence, where  the  semen  is  deposited,  whether  in  the  vagina  or  in 
any  other  receptacle."  This  conflict  in  the  opinions  of  the  authors 
is  easily  overcome  when  we  properly  consider  the  accompanying 
effect  of  the  psychical  factor,  which  varies  with  the  individuals, 
but  which  is  constantly  in  play.  Experience  shows  that  mastur- 
bation, since  opportunity  for  it  is  constantly  present,  is  much 
more  frequently  practiced  than  natural  sexual  indulgence.  The 
exhaustion  of  strength  induced  by  frequent  indulgence  points  to 
the  frequent  and  severe  material  injury  of  the  nervous  system. 
When,  by  reason  of  defective  or  incomplete  erection,  an  indi- 
vidual is  incapable  of  coitus,  masturbatic  friction  of  the  glans 
may  still  be  performed  with  a  flaccid  member.  The  majority  of 
cases  of  impotence  (on  this  point  all  authors  agree)  depend  upon 
excessive  and  early  indulgence  in  onanism. 

Hammond  states  that  he  observed  complete  impotence  in 
married  men  who  had  practiced  masturbation  moderately  with- 
out noteworthy  injury  to  their  general  health.  There  are  many 
young  men,  strange  to  say,  who  see  nothing  in  self-abuse  that  is 
immoral,  or  who,  at  least,  in  case  they  understand  the  evil,  are 
unable  to  resist  it.  Naturally,  after  marriage  they  find  that 
legitimate  intercourse  only  imperfectly  satisfies  their  sexual  in- 
stinct, and  that  it  excites  their  sensual  feeling  much  less  than  did 
the  evil  habit  in  which  they  previously  indulged  (Hammond).1 
The  dreams  which  accompany  the  onanistic  act  are  not  realized 
in  marriage,  and  to  the  great  surprise  of  such  patients  their 
virility  is  well-nigh  extinguished. 

At  the  same  time,  between  the  sexual  instinct  longing  for 
satisfaction  and  the  effort  to  remain  pure,  there  arises  a  terrible 
struggle,  which,  unfortunately,  only  too  often  ends  in  victory  for 
the  vice.2  From  this  arises  the  moral  depression  of  those  who 
abstain.  This  and  the  ever-renewed  struggle,  as  well  as  the 
onanistic  stimulation,  gradually  undermine  the  nervous  system.3 

1  Hammond,  loc.  cit. 

*  Comp.  Leopold  Caspar,  Impotentia  et  Sterilitas  Viriles,  Miinchen,  1890,  p.  77. 
'  Comp.  Beard, -Sexual  Neurasthenia;  and  von  Krafft-Ebing,  "  Neurosen  und  Psy- 
chosen  durch  sexuelle  Abstinenz,"  Jahrb.  fur  Psychiatric,  Bd.  viii,  pp.  1,  2. 

2 


18  SEXUAL   HYPER^ESTHESIA. 

In  the  course  of  time  weakness  of  the  whole  nervous 
system  occurs.1  At  the  same  time  it  is  important  whether  the 
pernicious  habit  has  been  practiced  from  early  youth  or  only 
from  after  about  the  twentieth  year.  The  earlier  the  vice  is 
indulged  in,  the  more  serious  are  its  effects.  In  the  functional 
injury  to  the  central  nervous  system,  the  loss  of  semen  is  not  of 
any  essential  pathogenetic  significance.  "  While  in  coitus  the  act 
is  quasi-reflex  and  automatic,  onanism  is  voluntary,  and  must 
be  attended  by  activity  and  expenditure  of  nervous  material 
which  possesses  a  higher  functional  value  "  (von  KrafFt-Ebing2). 
Meyer3  thinks  that  the  impulse  to  masturbate  is  stronger  and 
more  obstinate  when  the  result  of  psychical  predisposition, 
weaker  when  it  is  accidentally  p'rovoked.  In  the  first  instance, 
therefore,  it  has  a  more  injurious  effect  upon  the  mental  con- 
dition. 

With  reference  to  the  deleterious  effect  of  onanism  on 
children,  alienists  and  those  versed  in  the  hygiene  of  childhood 
agree  that  masturbation,  besides  inducing  motor,  sensory,  and 
circulatory  disturbances,  etc.,  may  give  rise  to  lack  of  feeling; 
want  of  desire  for  child-like  play,  in  as  far  as  this  does  not  give 
opportunity  for  the  vice ;  a  shy,  retiring  disposition ;  psychical 
irritability;  inclination  to  paroxysms  of  anger  and  rage;  and 
weakness  of  memory  and  judgment. 

"•  When  it  is  remembered  that  abnormal  precocity  of 
sexual  desire  is  one  of  the  peculiarities  of  a  neuropathic  con- 
stitution, the  conclusion  seems  justified  that  the  children  whose 
insanity  arises  from  onanism  have  been  under  the  influence  of 

1  Only  orthodox  one-sided  ness  of  view  and  complete  ignorance  of  physiological  con- 
ditions of  life  make  such  a  statement  as  the  following  explicable  :  "  Not  even  the  shadow 
of  a  proof  has  been  cast  to  show  that  a  nervous  man  is  made  nervous  or  insane  by  a  moral 
life, — i.e.,  complete  abstinence  from  sexual  intercourse."  (Comp.  A.  Rorner,  M.D.,  Die  Sit- 
tenreinheit  vor  dem  Richterstuhl  einer  arztliflien  Autoritat,  Streitfragen,  wisseuschaftliches 
Fachorgan  der  deutschen  Sittlichkeitsvereine,  Berlin,  1892.)  The  pamphlet  is  opposed  to 
the  works  of  Moll  and  von  Krafft-Ebing,  and  states  that  sexual  errors  arise  either  from 
"  seduction  "  or  from  "  personal  evil  "  (sic.')-  But  those  who  show  a  tendency  to  yield  to 
"  the  evil  inclinations  of  the  human  heart"  (p.  12)  should,  according  to  the  receipt  of  Dr. 
Romer,  call  to  mind  "  the  grand  words  of  the  Apostle  Paul  in  the  Epistles  to  the  Romans 
(i,  26,  27,  33),  as  well  as  in  those  to  the  Galatians  (v,  16  and  24)." 

a  Von  Krafft-Ebing,  Ueber  Irresein  durch  onanie  bei  Mannern,  v.  mpra. 

*  Ludwig  Meyer,  Die  Beziehungen  der  krankh.  Zustande  und1  Vorgange  in  den  Sex- 
ualerg.  des  Weibes  zu  den  Geistesstorungen,  Berlin,  1869,  p.  15  et  seq. 


ONANISM.  19 

that  evil  db  ovo"  (Vogel,1  UfFelmann2).  In  young  children 
masturbation  causes  convulsions,  choreic  conditions,  and  mental 
weakness.  According  to  Spitzka,3  between  the  fifth  and  tenth 
years  the  nutrition  of  the  brain  suffers,,  Such  children  are 
wanting  in  independent  thought  and  action.  At  the  age  of 
20  to  25  the  majority  of  onanists  feel  the  effects  most  seriously. 
Actual  nosomania  may  result.  If  such  cases  develop  actual 
insanity,  they  can  be  called  cases  of  masturbatic  insanity  only 
.when  the  connection  with  the  excesses  is  a  direct  one. 

Spitzka  occasionally  observed  mania,  melancholia,  epi- 
lepsy, stupor,  and  katatonia  in  young  onanists.  "  There  is  also 
a  form  of  delusional  insanity,  developing  during  and  after 
puberty,  which  deserves  the  name  of  masturbatic  insanity.  It 
is  chronic,  has  a  tendency  to  a  restless  form  of  dementia,  and  in 
its  beginning  it  is  characterized  by  anxiety,  fear,  suspicion,  and 
depression.  Later,  confusion  and  motor  excitement  occur ;  and, 
still  later,  rage  and  destructiveness "  (Spitzka4). 

Through  habitual  indulgence,  on  an  ism  becomes  instinctive ; 
and  the  vain  efforts  of  the  individual  to  overcome  it  under- 
mine his  strength  of  character.  Thus,  with  this  victory,  it 
becomes  a  genuine  pathological  manifestation,  whether  it  exist 
alone  or  in  connection  with  nervous  disturbances;  .and  then 
it  is  to  be  regarded  as  the  expression  of  a  cerebral  disease.  The 
most  frequent  results  of  masturbatic  excesses  are :  excessive 
pollutions  (day  and  night),  spermatorrhoea,  premature  ejacu- 
lation in  attempts  at  coitus,  hyperaesthesia  of  the  genital  centres, 
spinal  neurasthenia,  congestion  of  the  prostate,  inflammation  of 
the  urethra,  hyperamia  and  swelling  of  the  mucous  membranes, 
and  intense  sensitiveness  of  the  glans.  In  young  children, 
besides,  there  may  readily  occur  vesical  tenesmus,  wetting  of  the 
bed,  spasm  of  the  compressor  urethra),  and  urinary  incontinence. 
Further  results  are  urethritis,  prostatorrhcea,  spermatorrhoea, 
and  impotence.  * 

1  Vogel,  Lehrbuch  der  Kinderkrankh.,  5  aufl.,  p.  387. 

1  Uffelmann,  Handbuch  der  offentl.  und  privaten  Hygiene  des  Kindes.  Leipzig,  1881, 
p.  368. 

'  Spitzka,  "  Self-A'onse  in  Relation  to  Insanity,"  The  Dublin  Medical  Journal,  1887. 
4  Spitzka,  loc.  cU. 


20  SEXUAL     HYPEILESTHESIA. 

The  neurosis  of  the  lumbar  portion  of  the  cord  leads  to 
general  neurasthenia,  tachycardia,  pains,  praecordial  distress, 
feelings  of  pressure  and  weight  or  pains  in  the  eyelids,1  spasm 
of  the  lids,  photophobia  or  subjective  sensations  of  light,  dimi- 
nution of  the  acuity  of  central  vision,  neurasthenic  asthenopia, 
etc.  To  these  disturbances  Lowenfeld2  adds  the  so-called  eye- 
migraine. 

In  the  female  sex  there  are  similar  neurasthenic  and  hys- 
terical disturbances,  such  as  hysterical  attacks,  paralyses  (vesical . 
paralysis),  vesical  tenesmus  and  spasm,  ovarian  neuralgia,  weak- 
ness of  the  legs,  and  spinal  irritation.  Among  local  disturb- 
ances may  be  mentioned  hypersemia  of  the  labia  minora  and  the 
vaginal  orifice,  desquamation  of  the  epithelium,  fluor  albus,  cer- 
vical catarrh,  intense  hyperaesthesia,  pruritus  vulvae,  hypertrophy 
of  the  clitoris,  and  irritable  conditions  of  the  uterus  and  adnexa. 

A  condition  that  has  thus  far  been  too  little  studied,  and 
which  in  its  significance  is  one  of  the  most  important  and 
frequent  results  of  masturbation  in  the  female,  is  a  form  of  im- 
potence in  which  the  orgasm  no  longer  occurs  during  the  sexual 
act,  even  when  it  is  performed  with  several  men,  but  in  many 
cases  may  be  induced  post-coitum  by  masturbation.  In  the 
chapter  on  impotence  I  shall  consider  the  matter  more  in  detail. 
The  above-mentioned  change  of  character,  depending  upon  un- 
physiological  stimulation,  may  occur  in  woman  as  well  as  in 
man,  and  in  the  female  it  may  manifest  itself  in  a  more  serious 
disinclination  to  marry  (Tissot). 

Steinbacher 3  speaks  very  caustically  of  such  a  disposition  : 
"  They  think  they  can  satisfy  themselves  with  their  unnatural 
stimulation,  and  it  is  owing  to  this  circumstance  that  so  many 
remain  unmarried,  of  course  unconscious  that  health  and  life 
are  destroyed  by  the  unnatural  satisfaction  of  their  desires.  One 
sees  only  too  many  of  such  erring  old  maids  to  compare  with 
the  wife,  who  has  been  the  faithful  companion  of  her  husband, 
chaste  and  moderate  in  indulgence  and  moral,  and  the  mother 

1  Comp.  Cohn,  "  Augenkraukheiten  bei  Masturbanten,"  Archiv  fur  Augenlieilkunde, 
you  Knapp  und  Schweizer,  1882,  p.  198. 
9  Lowenfeld,  loc.  cit.,  p.  83. 
1  Steinbacher,  Die  mannliche  Impotenz,  Munchen,  1877,  p.  84. 


,         ONANISM.  21 

of  children.  It  is  astonishing  how  much  better  women  living 
a  full  life  are  preserved  up  to  an  old  age,  and  how  much  fresher 
and  more  joyous  they  appear  than  those  old  maids  who  suffer 
with  all  the  female  ills;  who  are  so  hysterical,  convulsive, 
yellow,  and  bigoted;  who,  insufferable  in  their  eccentricities, 
live  in  close  friendship  only  with  dogs  and  cats." 

The  question  whether  onanism  as  an  etiological  factor 
lends  specific  features  to  insanity  which  make  it  possible,  from 
the  clinical  symptoms,  to  ascertain  the  particular  cause,  von 
Krafft-Ebing,  on  the  basis  of  large  experience,  answers  in  the 
negative,  stating  that,  where  the  onanism  is  only  a  symptom  of 
disease,  or  where  it  is  an  exciting  cause  operating  with  a  neuro- 
pathic and  degenerate  constitution,  it  exercises  no  influence 
upon  the  clinical  form  of  the  malady ;  and  that  it  is  the  same 
when  it  induces  the  outbreak  of  insanity  and  rapidly  hastens 
the  psychical  and  physical  degeneration.  In  cases  of  the 
third  category,  where  onanism  forms  the  predisposing  causal 
factor  of  the  disease,  the  multitude  of  hallucinations  and  the 
ease  with  which  they  arise  are  striking. 

In  another  place l  the  same  author  distinguishes  two  forms 
in  the  pathogenesis  of  masturbatic  psychoses : — 

(a)  A  psychical,  through  assisting  mental  causes.  These 
are  spontaneous  mental  feelings, — remorse,  shame,  and  fear  of 
the  results  of  the  vice,  with  the  painful  consciousness  of  being 
unable  to  overcome  the  habit  by  strength  of  will.  In  such  cases 
melancholias  arise  with  intense  hypochondriacal  features  in 
harmony  with  the  predominating  symptoms  of  the  accompany- 
ing neurasthenia. 

(6)  The  cause  is  somatic,  through  the  addition  of  other 
weakening  influences  (insufficient  nourishment,  sleeplessness, 
physical  diseases,  mental  and  physical  strain).  The  form  of  the 
disease  here  seems  to  be  essentially  conditioned  by  constitutional 
factors.  If  these  be  slight  in  degree,  pure  exhaustion-neuroses, 
stupor,  and  delusional  states  occur ;  upon  a  degenerate  founda- 
tion are  developed  states  of  primary  dementia,  paranoia,  and 
insanity  with  imperative  conceptions. 

1  Von  Krafft-Ebing,  Lehrbuch  der  Psychiatric,  3  aufl.,  p.  208. 


22  SEXUAL    HYPER^STHESIA. 

• 

All  the  symptoms  occurring  in  the  sexual  psychoses  are 
more  or  less  those  of  neurasthenia,  as  are  olfactory  hallucinations 
of  a  repulsive  character. 

In  confirmation  of  von  Krafft-Ebing's  views,  Krapelin l  de- 
scribes the  psychical  degeneration  in  the  following  words :  "  Most 
frequently  in  onanists  there  occurs  a  progressive  loss  of  mental 
activity,  or  inability  to  comprehend  and  elaborate  mentally 
external  impressions,  weakness  of  memory,  lack  of  interest,  or 
dullness.  In  other  cases  symptoms  of  aggravated  irritability 
become  more  prominent ;  or  strange  associations  of  ideas,  incli- 
nation to  mysticism,  and  exalted  enthusiasm ;  or  hypochondri- 
acal  and  melancholic  depression.  With  these  are  associated 
various  nervous  disturbances,  especially  abnormal  sensations, 
from  which  not  infrequently  absurd  delusions  of  demoniacal  or 
secret  or  physical  (magnetic,  electrical,  sympathetic)  influences 
are  developed." 

From  what  has  gone  before,  it  is  plain  that  onanism  is  to 
be  regarded  as  -the  causal  or  exciting  factor  in  the  origin  and 
outbreak  of  numerous  forms  of  mental  disturbance ;  that  is, 
in  all  cases  with  a  neuropathic  constitution  or  in  connection 
with  other  assisting  causes,  it  is  capable  of  inflicting  serious 
injury  on  the  mind,  often  accomplishing  its  complete  destruction. 
The  following  figures  place  in  a  still  clearer  light  the  relation 
of  masturbation  to  insanity.  According  to  Ribbing's2  state- 
ments, the  admissions  of  insane  patients  to  the  asylums  of 
Sweden  were : — 

1883  .     .     .     643  cases,  of  which  25  were  due  to  onanism. 

1884  ...     704      "       "       "      19    "       "     "         " 

1885  ...     744      "       "       "      22     "       "      "         " 

1886  ...     741      "      "       "      35    "       "     "        " 

1887  ...     791      "       "       "      35    "       "     "        " 
Total,    .     .  3623      "       "       "    136     "       "     "         " 

This  constitutes  3.7  per  cent.  In  this  computation  those 
cases  are  also  included  in  which  onanism  was  only  an  accessory 
cause,  and  not  the  only  exciting  factor  in  the  induction  of 
insanity. 

1  Krapelin,  Psychiatric,  3  aufl.,  p.  33. 

•Ribbing,  Die  sexuelle  Hygiene,  3  aufl.,  p.  128  (Hobbing,  Leipzig,  1891). 


ONANISM.  23 

The  figures  for  three  years  in  England  were : — 

1885  .     .     .  13,158  cases,  of  which  160  were  due  to  onanism. 

1886  .     .    .  13,624      "      "        "      163     "       "     "        « 

1887  .     .     .  14,336      "       "        "      203     "       "     "         " 

And  the  percentages  for  each  year  were : — 

1885  .     .     .1.2  percent,  (males,  2.2  per  cent. ;   females,  0.3  per  cent.). 

1886  ...  1.1   "       "      (     "       2.0   "       "  "         0.3   "       "    ). 

1887  .     .     .1.4  "      "      (     "       2.6   "      "  "         0.2  "      "    ). 

Ellinger1  states  that  masturbation  was  an  accessory  cause 
in  83  cases  out  of  383  cases  of  insanity.  On  the  other  hand,  von 
Krafft-Ebing  points  to  the  fact  that,  in  38  of  his  cases  of  insanity 
due  to  onanism,  31  were  notoriously  predisposed  by  heredity; 
that  in  only  3  of  these  cases  did  the  insanity  begin  before  the 
fifteenth  year,  though  onanism  had  been  practiced  by  almost 
all  the  patients  from  early  childhood. 

Ludwig  Meyer2  observed  7  cases  of  onanism  in  girls 
ranging  in  age  from  1  to  9  years.  Of  these,  4  remained  men- 
tally intact ;  in  3  children  there  were  psychopathic  symptoms, 
and  of  these  2  had  a  neuropathic  predisposition,  and  the  third 
child  was  born  of  a  criminal  mother  and  presented  the  clinical 
picture  of  psychical  degeneration. 

Dr.  Peretti3  found,  among  300  male  patients  in  asylums, 
59,  or  19^  per  cent.,  in  whom  onanism  could  be  regarded  as  an 
accessory  cause  of  the  development  of  the  mental  disturbance 
(Ellinger  reckoned  21.5  per  cent.;  Dahl,  21.25  per  cent.). 
Thirty-three  out  of  the  59  became  insane  between  the  ages 
of  15  and  25 ;  and,  of  all  the  cases  admitted  between  the  ages 
of  15  and  25,  45.2  per  cent,  were  onanists.4 

According  to  Peretti's  statements,  onanism  induces  a  loss 
of  the  resistive  power  of  the  mind,  so  that  the  latter  is  thrown 
out  of  balance  by  a  very  slight  additional  disturbing  influence. 
The  first  signs  of  mental  disturbance  are  a  retiring  disposition, 
apathy  and  irritability,  and  an  hypochondriacs!  mood.  An 

1  Ellinger,  Allgem.  Zeitschr.  fur  Psychiatric,  Bd.  ii,  cited  by  von  Krafft-Ebing, 
"  Ueber  Irresein  durch  Onanie." 

*  Ludwig  Meyer,  loc.  cit. 

'  Peretti,  "  Ueber  Geisteskrankheit  bei  Onanfeteu,"  Die  prakt.  Arzt.,  1881,  ri. 

*  Comp.  Lombroso's  statements  on  page  4  of  this  book. 


24  SEXUAL   HYPER^ESTHESIA. 

insignificant  circumstance  may  be  sufficient  to  induce  a  com- 
plete outburst  of  despair,  fear,  or  an  attempt  at  suicide.  The 
hypochondriacal  depression  may  go  even  to  the  extent  of  hypo- 
chondriacal  paranoia.  Pure  melancholia  is  infrequent.  The 
mind  is  weakened,  and  the  attempts  at  suicide  have  a  theatrical 
character.  To  the  inconstancy  and  apathy  are  added,  later, 
hallucinations  and  ideas  of  persecution  and  conceit.  And  the 
suspicion  and  mistrust  lead  to  the  idea  of  being  watched,  fear 
of  persecutors,  and  to  attacks  on  those  supposed  to  be  inimical. 
This  goes  to  the  extent  of  senseless  confusion  and  violence.  In 
silent  patients  who  have  a  disinclination  to  employ  themselves, 
this  may  go  on  to  hallucinations.  Peretti  calls  this  "  mastur- 
batic  insanity," — moodiness,  with  sudden  changes ;  excitability ; 
phantasms  of  all  the  senses,  of  which  olfactory  hallucinations 
are  especially  frequent ;  fantastic  ideas ;  epigrammatic  phrases 
and  use  of  foreign  words  in  letters ;  increased  feeling  of  per- 
sonal importance  without  self-knowledge ;  idealistic  and  imprac- 
tical plans  for  the  future,  both  for  self  and  humanity. 

Among  physical  symptoms,  Peretti  found  a  blowing  sys- 
tolic murmur,  apex-sound  remarkably  loud,  cardiac  dullness 
normal,  changeable  pulse-rate,  cerebral  congestions,  and  anaemia. 

Finally,  we  may  here  allude  to  the  well-known  form  of 
masturbatic  paranoia  which  goes  by  the  name  "  erotomania." 
This  name  of  a  psychical  degeneration  means  a  tendency  to  fall 
in  love.  A  neuropathic  and  hysterical  predisposition  and  cere- 
bral diseases  may  favor  the  development  of  such  a  condition. 
The  love  of  such  individuals  is  purely  platonic ;  it  manifests 
itself  in  "  enthusiasm  for  a  person  of  the  opposite  sex  who  gives 
aesthetic  satisfaction,  or,  indeed,  sometimes  for  a  picture  or 
statue,"  etc.  (von  Krafft-Ebing).  They  are  unable  to  gratify 
their  passion  with  the  object  of  affection.  For  the  most  part, 
masturbation  gives  satisfaction  to  the  unbridled  fancy.  The 
patient  deifies  the  object  of  desire,  worships  it,  and  bores  his 
friends  with  unremitting  talk  of  the  object  of  his  abnormal  en- 
thusiasm. Gradually  and  unnoticed  the  pathological  disposition 
becomes  actual  disease.  Since  such  persons  constantly  inflame 
their  imagination,  and  in  solitude  resort  to  onanistic  stimuli, 


ONANISM.  25 

they  frequently  come  to  have  actual  illusions  and  hallucinations. 
"  The  delusions  of  love  become  complicated  with  ideas  of 
grandeur ;  or  they  become  transformed  into  those  of  perse- 
cution, in  that  the  ideas  of  love  may  alternate  with  hypochon- 
driacal  fears  "  (Tarnovvsky).1 

Cases  of  erotomania  belong  to  Magnan's2  fourth  group. 
In  such  patients  the  lower  sexual  instincts  of  the  occipital  arid 
spinal  centres  are  completely  at  rest,  while  perverse  sexual  ideas 
are  produced  in  the  frontal  region  without  becoming  transformed 
into  actual  sexual  stimuli  through  the  spinal  centres. 

The  points  made  may  be  summarized  as  follows : — 

A.   Onanism  in  Healthy  Individuals. 

1.  The  single  act  of  onanism,  in  comparison  with  normal 
coitus,  is  .injurious  to  the  central  nervous  system;  for  an  effort 
of  the  imagination  must  overcome  reality,  thus  requiring  the 
activity  and  waste  of  nervous  material  which  possesses  a  higher 
functional  value. 

2.  Masturbation,  when  practiced  no  more  frequently  than 
normal  coitus, — i.e.,  with  moderation, — aside  from  the  injurious 
influence  on  the  nervous  system  mentioned,  injures  the  character 
of  the  individual ;  for  it  undermines  the  physiological  relations 
with  the  opposite  sex,  and  thus  perverts  one  of  the  most  impor- 
tant sources  from  which  spring  the  impulses  to  exert  the  powers, 
both  in  individual  and  social  existence  (celibacy,  etc.);  and  by 
habitual  cultivation  the  unphysiological  excitement  may  attain 
an  instinctive  character.     This  victory  of  an  anomaly  of  habit 
over  the  will  must  be  looked  upon  as  a  sign  of  cerebral  disease. 
Besides,  the  memory-pictures  cultivated  by  onanism  may  become 
imperative  conceptions,  and  force  the  individual's  sexual  impulse 
into  a  perverse  direction. 

3.  Excessive    masturbation   leads,  also,  especially   where 
there  has  been  premature  awakening  of  the  sexual  instinct,  to 
spinal  and  general  neurasthenia,  to  genital  diseases  (pollutions, 
etc.),  and  to  early  impotence ;  it  injures  seriously  the  mental 

1  Tarnowsky,  op.  cit.,  p.  58. 
*  Comp.  Magnan,  loc.  ctt. 


26  SEXUAL   HYPER^ESTHESIA. 

development  of  the  individual,  and  it  may,  with  the  occurrence 
of  other  accidental  deleterious  influences  of  slight  importance 
per  se,  directly  induce  insanity. 

B.  Onanism  in  Persons  of  Hereditary  and  Neuropathic  Predisposition. 

As  a  rule,  here  it  is  practiced  excessively,  and  in  all  cases 
it  has  the  deleterious  influence  upon  the  nervous  and  mental 
condition  of  such  patients  mentioned  under  1,  2,  and  3.  In 
accordance  with  the  condition  and  age  of  such  onanists  the 
symptoms  enumerated  occur  with  increased  intensity,  lead  to 
progressive  loss  of  mental  power,  and  hasten  the  outbreak  of 
sexual  psychoses. 

Under  some  circumstances  the  diagnosis  of  onanism  is 
attended  with  difficulties.  Shame,  ignorance,  false  notions,  ex- 
cessive anxiety,  and  the  tendency  to  lie  are  often  sufficient  to 
vitiate  the  statements  of  patients.  In  many  cases  it  is  years 
before  the  parents  have  any  suspicion  of  the  child's  vicious  habit. 
In  many  families  no  attention  is  ever  given  to  the  matter,  and, 
unfortunately,  the  number  of  patients  who  come  to  understand 
it  only  when  they  have  reached  years  of  maturity  is  only  too 
great.  A  lady  of  my  clientele,  who  had  masturbated  from  her 
eighteenth  year,  reached  the  age  of  forty  before  a  medical  book, 
which  accidentally  fell  into  her  hands,  explained  the  matter 
to  her.  Another  of  my  patients  had  practiced  onanism  eight 
years,  and  completely  destroyed  her  nervous  system,  before  the 
physician  discovered  the  cause  of  her  trouble. 

Vogel,1  Uffelmann,  and  Emminghaus  think  that,  without 
exception,  at  a  very  early  age  children  have  an  instinctive 
notion  that  self-abuse  is  wrong ;  for  they  practice  it  in  secret, 
and  a  confession  can  seldom  be  obtained.  Owing  to  the  great 
prevalence  of  this  evil  habit,  when  there  is  anything  suspicious 
in  the  conduct  of  the  child,  or  where  the  mental  development 
leaves  anything  to  be  desired,  a  most  careful  watch  should  be 
kept.  The  places  where  onanism  is  cultivated  are  schools, 
academies,  prisons,  and  all  places  of  confinement ;  and,  too, 
the  educational  institutes  for  girls  are  not  to  be  excepted. 

1  Comp.  Vogel,  Uffelmann,  loc.  cit. 


ONANISM.  27 

Wherever  children  show  a  shy,  dreamy,  retiring  disposition, 
and  are  slow  in  school  and  difficult  to  induce  to  rise  betimes  in 
the  morning,  the  possibility  of  the  existence  of  the  habit  of  self- 
abuse  should  be  entertained.  Owing  to  the  establishment  of 
an  automatic  habit,  many  patients  masturbate  in  sleep.  In  such 
cases  the  diagnosis  has  been  made  certain  by  discovery  under 
such  circumstances.  One  of  my  patients  often  awoke  with  her 
finger  in  the  vagina.  Spots  of  semen  on  the  linen,1  spots  of 
blood  on  female  linen,  redness  of  the  labia  minora  and  the 
vaginal  orifice,  the  occurrence  of  spinal  pains  and  affections  of 
the  eye,  fluor  albus,  etc.,  are  important  indices. 

Griinfeld  states  that  he  has  quite  constantly  observed 
hyperaemia  of  the  colliculus  seminalis.  The  usual  symptoms 
are  dark-red  or  scarlet  coloring  of  the  colliculus  seminalis, 
with  increase  of  its  size  and  tenderness.  According  to  Gyurko- 
vechky,2  onanistic  excesses  lead  to  flaccidity  and  anaemia  of  the 
penis  and  testicles,  make  the  scrotum  smooth,  and,  owing  to 
relaxation  of  the  muscle  of  the  tunica  dartos,  cause  the  testicles 
to  hang  low.  The  meatus  is  reddened,  the  rest  of  the  urethra 
pale,  and  the  colliculus  inflamed  in  various  degrees. 

The  mental  and  physical  peculiarities  enumerated,  and 
consideration  of  the  symptoms  referable  to  its  results  that  have 
been  given  in  detail,  should  make  it  possible  to  make  a  certain 
diagnosis  of  onanism. 

The  prognosis  depends  upon  the  health  and  age  of  the 
patient.  Infrequent  indulgence  in  onanism  by  healthy  indi- 
viduals may  in  all  cases  be  overcome  by  natural  sexual  inter- 
course. Too,  even  where  there  is  a  habit  of  frequent  indulg- 
ence in  self-abuse  in  individuals  of  healthy  constitution  during 
the  years  of  puberty,  it  is  abandoned  as  soon  as  there  is  oppor- 
tunity for  hetero-sexual  intercourse.  Daily  experience  lends 
the  best  proof  of  this.  The  earlier  the  habit  is  begun,  the 
more  the  mind  has  become  implicated,  and  the  longer  and 
more  frequently  the  practice  of  self-abuse  has  been  indulged 

1  One  of  Dr.  Franz  Carl  Mailer's  patients  ejaculated  in  his  stockings  in  order  to 
escape  detection.     (Verbal  communication.) 
*  Gyurkovechky,  loc.  cit.,  p.  138. 


28  SEXUAL   HYPER^ESTHESIA. 

in,  the  more  unfavorable  is  the  prognosis.  But  even  patients  in 
whom  the  vice  has  become  instinctive  have  some  prospect  of 
cure  when  there  is  still  a  possibility  of  normal  sexual  inter- 
course. However,  in  relation  to  this,  it  must  be  remembered 
that  in  young  girls  this  equivalent  cannot  be  provided  except 
by  marriage,  which  does  not  always  rest  merely  with  the  desire 
'of  the  sufferers.  Even  with  a  neuropathic  constitution  there  is 
some  prospect  of  cure  and  improvement,  as  long  as  the  neuras- 
thenic condition  has  not  reached  the  intensity  of  a  psychosis. 
Where  masturbation  is  to.  be  regarded  as  the  symptom  of  a 
psychosis,  the  prognosis  depends  entirely  upon  the  fundamental 
disease. 

The  prognosis1  of  masturbatic  insanity  (paranoia  mastur- 
batoria),  especially  in  elderly  persons,  is  not  very  favorable,  even 
though  remissions  do  occur  and  tonic  treatment  is  possible. 
However,  even  here  cures  have  been  reported.  According  to 
von  Krafft-Ebing,2  the  prognosis  of  masturbatic  melancholia  is 
not  unfavorable. 

On  the  whole,  therefore,  the  prognosis,  in  all  cases  where 
complete  mental  and  sexual  deterioration  has  not  taken  place, 
is  decidedly  favorable ;  for  even  in  the  worst  cases  considerable 
improvement  is  possible. 

B.  SATYRIASIS  AND  NYMPHOMANIA. 

Abnormal  sexual  desire  is  an  intense  disturbance  in  the 
domain  of  the  feelings  and  the  will,  called  satyriasis  in  men  and 
nymphomania  in  women.3  Von  Krafft-Ebing  regards  this  sexual 
symptom-complex  as  a  part  of  a  psychosis  which  rests  upon  a 
psychical  hypersesthesia  (in  hysteria,  states  of  mental  exaltation, 
and  senile  and  paretic  dementia).  Here,  too,  the  transitions 
from  physiological  to  reckless  expressions  of  the  sexual  in- 
stinct, with  loss  of  all  normal  deterring  influences,  are  gradual. 
Emminghaus4  regards  the  immediate  re-awakening  of  desire, 

1  Peretti,  loc.  cit. 

a  Von  Krafft-Ebing,  Lehrbuch  der  Psychiatric,  3  aufl.,  p.  519. 

'  I  follow,  in  the  main,  voti  Krafft-Ebing's  exposition.     Comp.  Psychopathia  Sex- 
ualis,  p.  373,  and  Lehrbuch  der  Psychiatric,  p.  87. 
'  Emminghaus,  Psychopathologie,  p.  87. 


SATYRIASIS.  29 

after  satisfaction  of  it,  with  pre-occupation  of  the  entire  atten- 
tion, as  abnormal. 

In  Magnan's l  classification  these  symptoms  belong  to  the 
second  group, — i.e.,  disturbances  which  originate  in  those  sen- 
sory regions  of  the  cortex  which  lie  behind  the  central  convolu- 
tions, where,  according  to  this  author,  the  zone  of  the  desires 
and  instincts  lies,  and  which  are  influenced  quasi-automatically 
by  the  genito-spinal  centre  as  soon  as  the  forebrain  for  any 
reason  ceases  to  act.  As  examples,  Magnan  gives  two  cases  of 
women  suffering  with  extraordinary  sexual  excitement.  One 
locked  herself  in  her  room  to  avoid  the  sight  of  men,  who 
excited  her  desires  to  the  utmost ;  the  other,  the  mother  of  five 
children,  driven  by  similar  animal  desires,  would  surrender  her- 
self on  the  first  opportunity,  and  at  last,  in  despair  at  her 
suffering,  she  attempted  suicide. 

Causes  and  Symptoms. — While  married  life  bridles  the 
desire,  sexual  intercourse  with  different  persons  increases  it. 
The  imagination  creates  sexual  scenes  which  go  on  to  phan- 
tasms of  the  senses  with  hallucinatory  delirium.  .  "  Everything 
calls  up  sensual  thoughts,  and  the  lustful  coloring  of  ideas  and 
apperceptions  is  intense.  Feeling  and  will  are  entirely  under 
the  control  of  the  psycho-sexual  excitement "  (von  Krafft- 
Ebing). 

The  man  affected  with  satyriasis  seeks  to  satisfy  his  desire 
at  any  price,  and  thus  becomes  dangerous.  Here  enforced  ab- 
stinence 2  must  be  also  regarded  as  a  cause ;  it  leads  to  neuras- 
thenia, and  may,  with  an  increase  of  sexual  desire,  endanger 
the  freedom  of  the  will. 

In  animals,  too,  during  the  time  of  rutting,  the  procreative 
impulse  overcomes  all  other  desires  and  feelings,  and,  if  it  be  not 
satisfied,  leads  to  sexual  fury  and  perverse  acts.  Thus,  accord- 
ing to  Lombroso,3  nymphomania  has  been  observed  in  cows, 
mares,  hens,  angora  cats,  camels,  and  spiders ;  satyriasis,  in 
buffaloes,  dogs,  storks,  and  doves.  At  the  time  of  the  sexual 

1  Comp.  Magnan,  loc.  cit. 

9  Von  Krafft-Ebing,  "  Neurosen  und  Psychosen  durch  sexuelle  Abstinenz,"  Jahrb. 
fur  Psychiatric,  Bd.  viii,  1,  2. 

1  Lombroso,  Der  Verbrecher,  p.  20  et  seq. 


30  SEXUAL   HYPER^ESTHESIA. 

erethism  the  animals  are  uncontrollable,  and  bite  and  kill  any- 
thing that  comes  in  their  way ;  or  they  tear  their  own  flesh, 
tear  up  the  ground,  etc.  In  dogs  and  monkeys  onanism 
originates  in  this  way. 

Even  violent  sexual  attacks  upon  immature  animals,  and 
sodomitic  acts,  have  not  infrequently  been  observed  (for  ex- 
ample, in  large  studs)  as  a  result  of  unsatisfied  sexual  passion. 
Houzeau  saw  a  cock  attack  an  immature  pullet.  In  Egypt, 
Lessona  saw  an  ass  perform  sodomitic  acts  in  the  absence  of  a 
female.  For  the  same  reason,  faute  de  mieux,  sexual  union 
occurs  between  the  swan  and  goose,  between  the  elk  or  buffalo 
and  the  cow,  and  between  the  dog  and  wolf. 

Likewise  in  man,  enforced  abstinence  may  endanger  the 
freedom  of  the  will  and  lead  to  perversity  in  the  sexual  act. 
Thus,  a  case  is  known  to  me  where  a  criminal,  who  had  spent 
several  years  in  prison,  immediately  after  his  dismissal  raped  an 
old  woman  of  73  years  in  an  open  field.  A  second  case  was  one 
of  my  patients.  He  was  neurasthenic  and  previously  a  mastur- 
bator,  and  he  took  a  vow  in  a  students'  society  to  preserve  his 
chastity,  determined  to  abstain  at  any  cost.  After  he  had  been 
able  to  restrain  his  sexual  desires  for  some  time,  one  evening 
libido  came  over  him  with  all-conquering  force,  and  clouded 
consciousness.  He  was  unable  to  resist,  and,  in  a  confused 
state  of  mind,  he  followed  the  first  prostitute  he  met.  The 
result  was  that  he  had  great  moral  anguish  and  fear  of  having 
infected  himself;  for  he  had  performed  the  act  without  any 
precautions.  The  patient  stated  that  lie  was  beside  himself 
while  in  this  state,  which  resembled  intoxication.  A  third  case, 
in  which  impotence  followed  abstinence  of  five  years'  duration; 
is  reported  in  Section  II. 

Tarnowsky1  also  refers  the  origin  of  satyriasis  principally 
to  sexual  abstinence,  especially  under  the  influence  of  religious 
ideas.  "  For  example,  there  is  the  confession  of  the  Abbe  de 
Cours,  which  was  written  by  himself  and  published  by  Buffbn.2 
After  long  struggles,  fasting,  and  prayer,  all  women  began  to 

1  Tarnowsky,  loc.  ctt.,  p.  61. 

2Buffon,  Histoire  naturelle  de  1'homme. 


NYMPHOMANIA.  31 

/ 

appear  to  him  as  if  surrounded  by  electric  light.  Their  glance 
made  a  confusing  impression  on  him.  Later,  definite  hallucina- 
tions occurred :  he  imagined  that  the  governor  of  the  court  set 
all  women  after  him  in  order  to  induce  him  to  break  his  vows 
of  abstinence.  The  visions  of  St.  Anthony  were  much  more 
remarkable  than  this  confession  "  (Tarnowsky). 

There  may  arise  from  satyriasis,  priapism,  perversity  of 
sexual  acts,  exhibition,  rape,  lust-murder,  or  excessive  and 
shameless  masturbation.  The  genital  erethism  may  occur  in 
attacks,  intermittently  and  periodically  (Magnan). 

Sexual  hypersesthesia  occurs  more  frequently  in  women 
than  in  men.  "The  nymphomaniacal  woman  seeks  to  attract 
men  to  her  by  exhibition  or  lascivious  conduct,  and  at  the  sight 
of  a  man  she  becomes  intensely  excited  sexually,  and  satisfies 
herself  by  imitation  of  coitus  or  by  masturbation  ",  (von  Krafft- 
Ebing). 

Here,  too,  weak-mindedness  is  a  condition  which  consti- 
tutes a  favoring  predisposition.  Thus,  Sollier  reports :  "  Marie 
B.,  imbecile,  aged  22;  tall,  of  delicate  build.  She  stutters 
slightly ;  she  regards  herself  as  sharper  than  any  of  her  asso- 
ciates. When  13  she  consorted  with  one  of  her  father's  ser- 
vants, and  since  then  she  has  associated  very  frequently  with 
other  men.  She  imagines  that  every  man  she  sees,  no  matter 
what  his  social  position,  loves  and  wishes  to  marry  her.  She 
stands  at  the  window  and  throws  kisses  to  men  passing.  She 
practices  masturbation  excessively,  and  she  becomes  angry  and 
excited  when  kept  from  seeking  the  men  who  happen  to  be  in 
the  house,  in  order  to  surrender  herself  to  them." 

One  of  my  patients,  at  merely  the  sight  or  touch  (pressure 
of  hand)  of  a  man,  would  become  excessively  excited  sexually, 
and  satisfy  herself  by  means  of  ideal  cohabitation  or  masturbatic 
rubbing  with  the  thighs.  For  a  long  time  the  genital  erethism 
occurred  in  attacks  every  morning, — once  at  my  office.  In  spite 
of  the  presence  of  three  male  witnesses,  she  threw  herself  on 
an  ottoman,  and  in  hysterical  convulsions  masturbated  several 
times  before  our  eyes.  In  these  attacks  consciousness  is  clouded. 
"  In  women  the  intensification  of  sexual  desire  is  expressed  also 


32  SEXUAL   HYPER^ESTHESIA. 

in  shameless  exhibition ;  in  constant  washing  with  water,  saliva, 
and  urine ;  in  combing  and  undoing  the  hair ;  in  the  milder 
forms  of  self-adornment  and  flirting;  in  vacillation  between 
forwardness  and  modesty  or  sentimentality ;  or  in  'hand-squeez- 
ing, letter-writing,  suggestive  glances,  etc."  (Kraepelin).1  The 
most  frequent  consequence  of  nymphomania  is  prostitution. 
Von  Krafft-Ebing  calls  particular  attention  to  the  role  of  the 
sexual  sphere  in  relation  to  physicians.  Nymphomaniacal 
women  desire  gynaecological  examinations,  simulate  retention 
of  urine,  etc.  Post-menstrually,  sexual  desire  is  increased; 
and,  according  to  von  Krafft-Ebing,  at  such  times  in  neuro- 
pathic individuals  the  excitement  may  attain  a  pathological 
degree. 

In  harmony  with  him,  Neumann2  holds  the  opinion  that 
religious  fervor  and  an  inclination  to  indulge  in  religious  devo- 
tions are  to  be  regarded  as  clinical  equivalents.  "  The  religious 
idea  of  sexual  union  in  the  form  of  marriage;  the  relation  of 
the  Church  and  Christ,  which  is  looked  upon  as  that  existing 
between  the  bride  and  groom ;  the  period  of  puberty,  when  a 
state  of  feeling  arising  from  indistinct  sexual  sensations  is  fre- 
quently expressed  in  religious  enthusiasm ;  the  history  of  the 
saints,  in  which  are  told  the  efforts  to  subdue  the  flesh  ;  and  the 
practices  of  certain  sects,  whose  revivals  and  meetings  often 
become  terrible  orgies,  are  proofs  of  the  physiological  and  inner 
organic  relations  existing  between  religious  fervor  and  sexual 
desire.  Of  the  same  nature  is  the  impulse  in  maniacal  virgins 
to  make  pilgrimages  and  do  missionary  work,  or  to  become 
nuns  or,  at  least,  the  servants  of  priests ;  and  they  commonly 
talk  much  of  virtue  and  virginity"3  (von  Krafft-Ebing). 

The  relation  of  religion,  lust,  and  cruelty  von  Krafft-Ebing* 
reduces  to  the  following  formula :  "  States  of  religious  and 
sexual  excitement,  at  the  height  of  their  development,  exhibit 
a  correspondence  in  quantity  and  quality  of  excitement,  and 
therefore,  under  favoring  circumstances,  one  may  take  the  place 

1  Kraepelin,  loc.  ctt.,  p.  139. 

'Neumann,  Lehrbuch  der  Psychiatric,  p.  80. 

1  Von  Krafft-Ebing,  Psychiatric,  p.  89. 

4  Von  Krafft-Ebing,  Psychopathia  Sexualis,  p.  8. 


NTMPHOMANIA.  33 

of  the  other.  Both,  under  pathological  conditions,  may  become 
transformed  into  cruelty." 

The  diagnosis  of  this  form  of  sexual  hypersesthesia  pre- 
sents no  difficulties. 

In  relation  to  prognosis,  what  has  been  said  concerning 
masturbation  must  be  recalled ;  for  the  abnormal  sexual  desire 
may  result  from  it,  just  as  onanism  may  be  symptomatic  of 
hyperajsthesia ;  and,  too,  the  fundamental  psychopathic  or  neuro- 
pathic disposition  must  be  taken  into  account. 


CHAPTER  II. 

THERAPEUTIC   SUGGESTION   IN   THE   TREATMENT 

OF   ABNORMAL   INTENSIFICATION   OF 

SEXUAL   DESIRE. 

THE  close  relationship  of  the  various  forms  of  onanism 
among  themselves  and  with  those  of  sexual  hyperaesthesia 
(satyriasis,  nymphomania,  erotomania,  etc.),  and  the  similarity 
of  therapeutic  procedures  in  the  groups  of  symptoms  described  in 
Section  I,  make  it  seem  best  to  give,  in  a  single  chapter,  a  com- 
prehensive description  of  the  curative  methods  and  the  problems 
which  meet  the  physician  in  the  treatment  of  the  various  forms 
in  which  sexual  excitement  is  expressed. 

First  of  all,  the  cause  of  the  sexual  erethism,  of  the  mas- 
turbation and  its  consequences,  of  the  premature  arousing  of 
libido  sexualis,  must  be  removed.  The  most  important  duty  of 
parents  and  teachers,  and  one  which,  unfortunately,  through 
ignorance  or  false  modesty,  is  neglected,  consists  in  prophylaxis, 
— in  a  rational  sexual  education  suitable  to  the  process  of 
sexual  development. 

In  many  schools  and  academies  masturbation  and  vice  are 
actually  cultivated.  To-day  too  little  attention  is  given  to  the 
mental  and  moral  condition  of  pupils.  If  the  lessons  are 
learned,  the  principal  requirement  is  fulfilled.  That  many 
pupils  are  thus  ruined  in  body  and  soul  is  never  considered. 
With  silly  prudery  the  sexual  life  is  veiled  from  the  developing 
children,  and  not  the  slightest  notice  is  taken  of  the  excitation 
of  their  sexual  instinct.  It  is  thought  best  to  leave  all  to 
nature.  In  the  meantime  nature  rises  in  her  might  and  leads 
astray  (von  Krafft-Ebing.)1  With  children  strict  and  intelligent 
oversight  is  necessary,  and  when  there  are  indications  of  com- 
mencing onanism  or  other  signs  of  premature  awakening  of 
sexual  instinct,  energetic  treatment  should  begin  immediately, 
if  possible  under  the  direction  of  a  physician  educated  in  psy- 

1  Vou  Krafft-Ebiug,  Psychopathia  Sexualis,  p.  321. 

(34) 


ABNORMAL   INTENSIFICATION    OF    SEXUAL   DESIRE.  35 

chology,  and  capable  of  the  employment  of  suggestion.  The 
means  for  the  detection  of  onanism,  for  the  most  part  at  least, 
have  been  made  clear  in  the  exposition  of  the  symptomatology 
and  diagnosis  of  masturbation.  Fournier's1  work  also  gives 
more  details. 

The  children  should  be  observed  while  at  play,  to  ascertain 
whether  they  there  give  evidence  of  sexual  excitement,  and 
whether  the  manner  of  play  corresponds  with  the  sex.  Thus, 
playing  "  papa  and  mamma  "  or  "  being  engaged  "  may  attain 
pathological  significance.  Preference  by  boys  for  girlish  games 
and  employments,  and  vice  versd  by  girls,  may.  with  indulgence 
on  the  part  of  the  'parents,  in  further  development  lead  to  a 
change  of  character  in  the  sense  of  contrary  sexuality.  A 
typical  example  of  this  kind  is  offered  in  the  celebrated  case  of 
Count  Sandor  (alias  Countess  Sarolta  V.).  The  father  of  the 
countess  allowed  her  from  childhood  to  go  about  in  boys' 
attire,  educated  her  as  a  boy,  had  her  ride,  drive,  and  hunt, 
and  said  to  her :  "  Why,  you  are  a  man ;  with  your  energy, 
that  is  at  once  evident."  Her  tutor,  Daniel  K.,  most  inaptly 
gave  her  sensuality  a  perverse  direction.  The  child's  mother 
had  no  influence  in  her  education.2  With  full  weight  given  to 
the  hereditary  taint,  the  mental  weakness,  etc.,  it  still  seems 
questionable  whether  the  disease  of  the  Countess  Sarolta  V., 
without  these  artificial  influences,  would  have  taken  the  same 
fatal  direction. 

The  pathological  importance  of  educational  influence  in 
originating  such  conditions  will  be  later  placed  in  the  clearest 
light  by  numerous  sad  cases  of  contrary  sexuality.  In  youth  a 
cure,  or  at  least  compensation,  may  be  most  hopefully  sought. 
At  the  first  sign  of  puberty  children  should  be  taught  to  under- 
stand the  sexual  relations  and  the  results  of  abuse.  Their  fancy 
should  be  supplied  with  pure  nutriment,  and  the  education  at 
school  should  avoid  those  things  mentioned  above  which  may 
play  the  role  of  seducer.  Where  there  is  a  perverse  and  neuro- 
pathic disposition  great  care  must  be  exercised  in  order  that  the 

1  Fournier,  De  1'onanisme.    4th  ed.     Paris,  1885. 

1  Comp.  Friedreich's  Blatter  fur  gerichtl.  Mediciu,  1891,  Heft  I,  p.  8. 


36  SEXUAL   HYPEILESTHESIA. 

development  of  the  instinct  be  delayed  as  long  as  possible. 
Such  experienced  physicians  as  Moll1  and  Tarnowsky  express 
themselves  to  this  effect.  Furthermore,  separation  of  the  sexes 
is  to  be  avoided  as  far  as  possible,  though  the  training  must 
be  devoid  of  all  influences  which  lead  to  sexual  excitement. 
Moreover,  the  relation  of  servants  to  children  must  be  strictly 
watched.  The  cases  in  which  infants  who  cry  are  quieted  by 
genital  manipulation  are  none  too  infrequent,  as  are  instances 
of  seduction  of  immature  children  to  attempt  coitus,  onan- 
ism,  etc. 

The  question  whether  indulgence  in  coitus  is  to  be  allowed 
in  mature  individuals  has  given  rise  to  manyconflicting  opinions, 
which,  owing  to  the  importance  of  the  subject,  we  cannot  over- 
look. Several  investigators,  as  Acton,2  Beale,3  Paget,4  and 
Govvers,5  contend  that  abstinence  has  no  injurious  effect  upon 
the  health.  They  permit  sexual  intercourse  only  in  marriage. 
Augagneur 6  remarks :  "  In  order  to  stamp  prostitution,  as  a 
crime  under  all  circumstances,  it  is  necessary,  by  unequivocal 
laws,  to  make  sexual  intercourse  outside  of  the  marriage  rela- 
tion a  crime."  Ribbing  would  combat  onanism  by  hygienic, 
moral,  and  religious  instruction.  He  has  seen  cases  in  which 
such  individuals  were  really  successful  in  overcoming  their  sad 
malady,  "without  resorting  to  a  life  of  debauchery  or  marriage."7 
The  same  author  says  further :  "  Chastity  harms  neither  mind 
nor  body.  Little  as  I  should  advise  a  Don  Juan  to  give  him- 
self to  onanism,  I  should  be  as  far  from  attempting  to  cure 
onanism  by  means  of  debauchery."  He  pleads  for  the  punish- 
ment of  prostitution,  but  has  to  confess  (p.  184)  "that  we  are 
far  from  the  state  of  nature,  and  have  found  no  modus  vivendi 
in  accord  with  culture  and  its  requirements."  Forel,8  who,  in 

1  Moll,  Contrare  Sexualeinpfiriduug,  1891,  p.  214. 

a  Acton,  On  the  Reproductive  Organs. 

1  Beale,  Our  Morality  and  the  Moral  Question,  1887. 

4  Paget,  Cited  by  Beale. 

*  Gowers,  London  Lancet,  1889. 

•Prophylaxe  publique  de  la  Syphilis,  par  A.  Fournier,  Paris.  1887,  pp.  10,  11. 

1  Ribbing,  Sexuelle  Hygiene  und  ihre  ethischen  Consequenzen,  Leipzig,  3  aufl., 
pp.  127, 131,  et  seq. 

•Forel,  "  Einige  Worte  iiber  die  reglementirte  Prostitution,"  Correspondeuzbl.  fur 
Schweizer  Aerzte,  Jahrg.  xix,  1889. 


ABNORMAL   INTENSIFICATION    OF    SEXUAL   DESIRE.  37 

general,  is  an  opponent  of  prostitution,  allows  that  there  are 
sexual  neurasthenics  who  are  intensely  excited  by  pollutions, 
but  who  find  relief  in  normal  intercourse."  Lowenfeld1  con- 
firm's  Forel's  experience  with  the  observation  that  occasional 
interruption  of  customary  regular  intercourse  has  a  deleterious 
effect  upon  neurasthenic  conditions.  Von  Krafft-Ebing  has 
shown,  though  it  be  with  a  series  of  cases  that  might  be  con- 
sidered not  entirely  sufficient,  that  a  state  of  general  nervous 
excitement  may  arise  as  a  result  of  repression  of  one  of  the 
most  powerful  instincts,  and  that  in  individuals  of  neuropathic 
predisposition  enforced  abstinence  may  give  rise  to  danger  of 
nervous  and  mental  diseases.2  Thus,  continued  sexual  exci- 
tation without  adequate  satisfaction  of  it  affects  the  health 
injuriously,  as  occurs  not  infrequently  in  marriages  between 
elderly  men  and  young  women.  As  a  result  of  the  constant 
excitement  and  hypersemia  of  the  genital  organs,  without 
gratification,  irritable  weakness  of  the  genital  apparatus  and 
its  nerve-centres  may  ensue.  According  to  von  Krafft-Ebing, 
in  predisposed  individuals  the  results  of  abstinence  are  essen- 
tially the  same  as  those  of  onanism.3  Of  course,  very  few  men 
possess  sufficient  strength  of  will  to  come  off  conquerors  in 
the  conflict  between  sensuality  and  reason.  The  vast  majority, 
when  opportunity  for  normal  sexual  indulgence  is  not  offered, 
fall  into  the  vice  of  self-abuse  or  perverse  gratification  of  the 
sexual  impulse,  thus  choosing — if  non-marital,  but  normal, 
sexual  intercourse  may  be  called  an  evil — the  greater  of  two 
evils. 

The  entire  process  of  development  of  the  human  organism 
tends  to  put  the  individual  into  the  most  favorable  condition  for 
the  performance  of  the  sexual  functions.  The  conditions  of  life 
standing  in  opposition  to  a  physiological  need,  to  an  instinct 
possessing  the  same  justification  and  strength  as  the  desire  for 
food,  can  be  of  no  possible  use  to  the  organism,  of  which  medi- 
cal experience  offers  the  best  proof.  "  The  idea  of  complete 
health  includes  complete  and  regular  satisfaction  of  all  the 

1  Lowenfeld,  loc.  cit.,  p.  17. 

1  Krafft-Ebing,  Jahrbucher  fur  Psychiatric,  viii,  pp.  1,  2. 

1  Krafft-Ebing,  Psychiatric,  p.  209. 


38  SEXUAL   HYPER^STHESIA. 

needs  of  man,  and  that  is  the  goal  for  which  hygiene  must 
strive,  and  not  seek  to  stifle  one  of  the  most  important  func- 
tions of  the  organism,  like  the  sexual  instinct.  The  recom- 
mendation to  voluntarily  destroy  any  function  like  the  idea  of 
love  is  a  subject  for  the  fanatic,  but  directly  opposed  to  hy- 
giene "  (Tarnowsky). l 

As  long  as  society  is  not  in  a  position  to  offer  to  every 
mature  individual  satisfaction  of  the  sexual  appetite  in  some 
generally-recognized  form,  as  in  marriage,  it  is  senseless  to 
oppose  non-marital  sexual  intercourse,  and,  in  societies  for 
abolitionism,  to  seek  to  cultivate  absolute  sexual  continence. 
To  combat  prostitution  with  police  regulations  and  laws  is  but  a 
way  in  which  to  withdraw  from  medical  and  organized  legal 
supervision  immorality  and  contagious  disease  and  transfer 
them  to  the  family,  as  Tarnowsky,  in  his  instructive  work,2  with 
the  presentation  of  abundant  evidence,  shows.  Forel,3  likewise 
with  resort  to  statistical  material,  makes  an  opposite  statement. 
In  his  opinion,  secret  prostitution  is  neither  so  dishonoring  nor 
so  abnormal  and  dangerous  as  public  prostitution.4  The  roots 
of  this  phenomenon,  which  is  still  especially  favored  by  the 
constitution  of  modern  social  life,  are  to  be  sought  in  the  varied 
intensity  of  sexual  instinct ;  in  the  varying  strength  of  the 
need  to  satisfy  it;  in  the  variation  of  power  of  resistance  in 
different  individuals  to  passionate  desires ;  in  physical  and 
mental  defects  of  development  (therefore  in  defect  of  moral 
sense) ;  and,  finally,  in  poverty  and  ignorance.  The  limitation 
of  the  evil  to  a  minimum,  which  seems  to  every  one  of  any 
knowledge  of  the  subject  both  desirable  and  attainable,  with 
any  prospect  of  relative  success,  can  only  be  brought  about 
through  an  inner  reform  of  society ;  through  correct  education 

1  Tarnowsky,  Prostitution  und  Abolitionismus,  Hamburg,  1890. 

9  Ibid.,  p.  31. 

"Forel,  Zur  Frage  der  etaatl.  Regulirung  der  Prostitution  (Bremerhaven  und  Leip- 
zig, Lienken),  1892,  p.  18.  Unfortunately,  I  was  unable  to  obtain,  in  time  to  use  them 
for  this  work,  the  books  recommended  by  Forel,  "  Fiaux,  Les  maisons  de  tolerence  "  (Paris, 
1892). 

4  In  the  consideration  of  this  question,  the  proportion  of  public  to  private  prosti- 
tution in  Berlin  is  important.  While  more  than  5000  prostitutes  are  registered,  according 
to  police  estimates  more  than  50,000  live  by  prostitution.  Comp.  Aerztl.  Vereinsblatt, 
Marz,  1892,  p.  93. 


ABNORMAL   INTENSIFICATION   OF   SEXUAL   DESIRE.  39 

of  the  young  and  the  ignorant ;  and  through  an  increase  of 
facility  of  marriage  and  amelioration  of  conditions  of  life. 
"  For  the  more  undeveloped  an  individual  is,  the  more  reckless 
he  is  in  the  gratification  of  his  desires."  We  should  institute 
a  real  sexual  education,  and  lead  the  matured  sexual  instinct, 
by  means  of  the  preservation  of  rational  indulgence,  into  paths 
devoid  of  danger;  we  should  make  needful  concession  to  the 
natural  impulse ;  and,  thus,  public  vice,  with  its  results, — the 
unlimited  spread  of  venereal  diseases  and  the  increasing  number 
of  crimes  against  morality, — would  be  greatly  diminished,  and 
become  more  and  more  confined  to  the  step-children  of  nature 
(those  subject  to  congenital  viciousness).  But,  more  than  all, 
the  foundation  would  be  removed  upon  which  rest  masturbation 
and  the  development  of  the  sexual  instinct  in  perverse  direc- 
tions.1 

We  might  thus  dispel  the  greater  evil  with  the  lesser ;  for 
it  is  nonsense  to  think  of  abolishing  the  evil  entirely.  The  best 
cure  for  onanism  and  other  manifestations  of  sexual  hyperaes- 
thesia — with  few  exceptions,  there  can  be  no  doubt  upon  this 
point — lies  in  regular  sexual  indulgence.  The  condition  of 
society  to-day,  of  course,  allows  a  man  much  more  freedom  and 
opportunity  in  this  direction  than  a  woman,  with  the  unques- 
tioned acknowledgment  that  his  sexual  desires  are  much  more 
intense  than  hers.  "  In  the  highly-civilized  state  of  the  social 
life  of  to-day,  woman  in  a  sexual  role  and  serving  the  social  and 
moral  interests  of  society  can  be  thought  of  only  as  a  wife  "  (von 
KrafFt-Ebing).  The  aim  and  ideal  of  a  woman  is,  and  remains, 
marriage.  For,  as  Mantegazza  justly  remarks,  she  demands  not 
only  satisfaction  of  her  sensual  desires,  but  also  protection  and 
maintenance  for  herself  and  her  children.  However,  upon  con- 

1  The  Committee  of  Management  of  the  Prussian  Society  of  Physicians,  in  its 
meeting  of  December  13, 1891,  in  considering  the  question  of  prostitution,  touched  upou 
the  subject  of  sexual  education.  There  was  no  difference  of  opinion  as  to  the  fact  that  the 
sensual  impulses  which  lead  to  non-marital  intercourse  can  in  no  way  be  restrained  by 
public  police  regulations.  On  this  occasion,  attention  was  drawn  to  Lassar's  deserving 
work,  who,  in  two  articles  ("  Prostitution  und  Geschlechtskrankheiten,"  Hygienische 
Rundschau,  1891,  No.  23;  and  "Die  gesundheiteschadliche  Tragweite  der  Prostitution," 
Berlin,  A.  Hirschwald),  points  teachers  to  the  duty  of  having  courage  to  teach  developing 
youths  and  warn  them  against  the  dangers  of  infection.  The  committee  appointed  a  com- 
mission to  make  a  report  upon  measures  for  preventing  the  further  spread  of  syphilis. 


40  SEXUAL    HYPEK^STHESIA. 

sidering  the  obstacles  to  matrimony  which  exist  in  the  social 
relations  of  to-day,  and  which,  on  the  one  hand,  make  marriage 
impossible  for  many  women ;  and  upon  considering  the  extraor- 
dinary dangers  and  disadvantages  which  attend  all  manner  of 
unnatural  sexual  indulgence,  must  we  not  acknowledge  that  it 
is  better,  as  Steinbacher l  says,  ,to  give  to  the  world  the  healthy 
fruit  of  a  passionate  love  than,  through  sins  against  self,  against 
nature  and  health,  "  in  invalidism  and  misery,  to  stamp  youthful 
years  with  the  most  repulsive  mark  of  old  age  1 " 

The  strength  and  intensity  of  the  sexual  instinct,  like 
moral  and  physical  individuality,  are  too  various  to  make  it 
necessary  to  give  a  general  application  to  the  foregoing  state- 
ments. Such  a  misunderstanding  might  become  a  welcome 
license  and  cloak  for  all  possible  expressions  of  vice,  and  it 
would  open  the  door  to  sensuality.  While  one,  thanks  to  the 
inherent  peculiarities  of  his  organization,  can  easily  practice 
abstinence,  another  is  led  to  onanism,  and,  as  a  result  of  it,  is 
utterly  ruined  if  he  has  no  opportunity  for  natural  sexual 
indulgence.  Only  after  the  most  careful  study  of  the  single 
case  can  it  be  determined  how  far  and  in  what  way  the  sexual 
appetite  should  be  satisfied.  From  the  stand-point  of  sexual 
hygiene,  the  principle  of  the  weakest  force  must  be  as  deter- 
minate here  as  in  nature  in  general.  Therefore,  the  chaste 
youth  should  exercise  sexual  abstinence  as  long  as  he  is  able  to 
restrain  the  instinct  without  injury  to  his  health.  Should  he 
be  in  danger,  owing  to  increasing  strength  of  his  sexual  impulse, 
of  onanism,  of  falling  a  victim  to  satyriasis,  or  perverse  sexual 
indulgence,  then  it  becomes  the  duty  of  his  teacher  and  his 
physician  to  cause  indulgence  in  coitus  and,  too,  to  acquaint  the 
neophyte  with  precautionary  measures  which  will  guard  against 
excesses,  infection,  and  the  procreation  of  illegitimate  offspring 
which,  under  certain  circumstances  (e.g.,  with  contrary  sexu- 
ality), may  be  hereditarily  tainted.  Individual  sexual  capa- 
bilities should  determine  the  frequency  of  sexual  indulgence. 
It  is  impossible  to  fix  a  normal  standard.  Acton  allows  but  one 
act  of  coitus  a  week;  Martin  Luther  allows  two;  but,  on  the 

1  Steinbacher,  loc.  cit.,  p.  85. 


ABNORMAL   INTENSIFICATION   OF   SEXUAL   DESIRE.  41 

other  hand,  the  Queen  of  Aragon  recommended  six  sexual  acts 
a  day.  "  The  Talmud  directs  one  coitus  a  day  for  a  man  who 
is  well  and  strong  and  not  working  hard ;  for  mechanics,  two 
a  week ;  while  students  and  laborers  are  to  indulge  but  once  a 
week."1 

Concerning  the  advisability  and  injurious  effects  of  so-called 
"  preventives,"  opinions  also  differ.  Gyurkovechky2  allows  that 
only  those  who  have  some  idea  of  what  it  is  to  have  "  eight 
children  and  little  bread  "  have  any  right  to  speak  for  or  against 
the  employment  of  such  measures.  A  means  which  is  much 
lauded,  and  used  especially  in  France,  for  the  prevention  of  con- 
ception (known  by  the  name  "  fraudiren," — coitus  interruptus), 
consists  in  withdrawing  the  penis  from  the  vagina  immediately 
before  ejaculation,  which  then  takes  place.  In  my  opinion, 
there  is  no  doubt  that  congressus  interruptus  is  an  act  harmful 
to  health.  Peyer 3  saw  fourteen  patients  suffering  with  spinal 
neurasthenia,  spermatorrhoea,  neuralgia  testis,  sexual  asthma, 
cardiac  palpitation,  etc.,  resulting  from  it.  At  the  instant  of 
most  intense  excitement  the  ejaculation  is  voluntarily  postponed 
as  long  as  possible ;  complete  retreat  takes  place  with  a  great 
expenditure  of  physical  and  mental  energy.  "  The  action  of 
the  prostatic  muscle  and  the  bulbo-  and  ischio-  cavernosus  mus- 
cles is  no  longer  natural,  unobstructed,  and  energetic,  but  modi- 
fied and  weakened."  In  a  woman,  the  sudden  cessation  of  friction 
during  the  height  of  orgasm,  before  the  feeling  of  ejaculation, 
with  its  consequent  sense  of  satisfaction,  has  taken  place,  may 
induce  disturbances  of  the  nervous  and  sexual  systems.4  In 
contrast  with  this  theory  of  Peyer  and  Bergeret,  Gyurkovechky 
states  that  he  has  seen  persons  who  bore  this  procedure  well. 

Of  all  the  means  for  the  prevention  of  conception,  the 
condom  seems  relatively  the  least  injurious  for  both  parties ; 
and  it  affords  relatively  the  greatest  protection  against  infection 
and  pregnancy.  Therefore,  as  does  Gyurkovechky,5  we  can 
recommend  to  our  patients  a  well-made,  elastic  condom. 

'Comp.  Gyurkovechky,  loc.  cit.,  p.  88. 

"  Gyurkovechky,  loc.  cit.,  p.  143. 

1  Peyer,  Der  unvollstaridige  Beischlaf,  Enke,  Stuttgart,  1890. 

*  Bergeret,  Des  fraudes  dans  1'accomplisment  des  fractions  generatrices,  Paris,  1884. 

'  Gyurkovechky,  loc.  cit.,  p.  144. 


42  SEXUAL   HYPER^ESTHESIA. 

In  the  foregoing,  the  fundamental  features  of  sexual  pro- 
phylaxis have  been  sketched  in  all  its  most  essential  points,  in 
accordance  with  the  principles  of  hygiene.  To  emphasize  it 
again,  the  most  important  principle  is,  and  remains,  individuali- 
zation.  No  prudery,  no  false  modesty,  should  keep  us  from 
giving  the  same  care  and  attention  to  the  most  powerful  of 
natural  instincts  which  everybody  gives  to  other  physical  func- 
tions,— such  as  is  given  to  nutrition !  Whole  libraries  are 
written  about  appropriate  and  healthful  diet,  but  there  is  hardly 
to  be  found  a  single  book  resting  on  a  strictly  physiological 
basis  concerning  the  care  of  the  sexual  functions !  Numerous 
popular  and  error-breeding  works  and  the  products  of  an  ex- 
treme asceticism  are  the  only  substitutes  that  have  yet  been 
offered  to  youth  seeking  knowledge. 

A  sexual  education  which  takes  account  of  all  the  physio- 
logical needs,  in  all  therapeutic  measures  directed  against 
psycho-sexual  disorders,  is  an  important  and  indispensable  part 
of  the  psychical  treatment.  The  application  of  suggestion  is 
for  the  physician  an  excellent  means  of  methodically  disciplining, 
in  the  most  effectual  and  quickest  manner,  the  patient's  feelings 
in  accordance  with  these  educational  measures.  Above  all,  this 
is  true  in  those  cases  in  which  psychical  treatment  in  the  non- 
hypnotic  state  progresses  slowly  or  is  ineffectual.  For  this 
reason,  in  this  book,  sexual  education,  as  an  important  part  of 
psycho-therapeutics,  must  be  considered. 

Before  we  pass  on  to  therapeutic  suggestion  in  its  narrower 
sense,  we  may  review  briefly  other  customary  methods  of  treat- 
ment, since  it  is  often  necessary  to  use  combined  means.  Here 
we  may  limit  ourselves  to  a  review  of  the  most  necessary  meas- 
ures, with  citation  of  several  excellent  works  on  impotence, 
neurasthenia  sexualis,  etc.,  which  give  other  methods  of  treat- 
ment in  detail. 

We  have  an  important  aid  in  hygienic  measures.  The 
patients  should  lead  a  life  tending  to  strengthen  them.  The  diet 
must  be  nutritious  and  unstimulating,  and  digestion  must  be 
regulated.  Meats  must  be  taken  moderately  >  and  there  must  be 
great  moderation  in  the  use  of  alcoholics.  Supper  should  be 


ABNORMAL   INTENSIFICATION   OF    SEXUAL   DESIRE.  43 

taken  three  hours  before  retiring.  Onanists  should  not  sleep 
more  than  seven  or  eight  hours,  and  they  must  be  compelled  to 
rise  early.  Persons  who  masturbate  automatically  in  sleep  are  to 
be  provided  with  appropriate  mechanical  devices  for  arms  and 
feet  to  prevent  the  act,  and  the  genitals  should  be  protected 
with  a  proper  bandage.1  Above  all  things,  the  onanist  must 
avoid  solitude  and  have  no  opportunity  to  dream.  The  imagi- 
nation must  be  given  healthful  food,  and  the  patient  must  be 
usefully  employed  from  morning  until  night.  Rational  gym- 
nastic exercise  and  long  walking  tours  lessen  the  excitability  of 
the  sexual  centres.  In  addition,  there  should  be  massage,  swim- 
ming, etc.  In  the  choice  of  diversions,  according  to  the  indi- 
vidual, such  things  are  to  be  scrupulously  avoided  as  tend  to 
excite  the  imagination  to  psychical  onanism.  First  of  all,  the 
cause  of  the  habit  is  to  be  removed:  remedy  a  phimosis;  obviate 
other  conditions,  induced  by  bodily  conditions  or  external  cir- 
cumstances, which  cause  excitement,  pruritus,  etc.  The  results 
of  onanism — spermatorrhoea,  etc. — are  to  be  treated  locally. 

HydrotJierapeutic  procedures  are  to  be  recommended  in 
almost  all  cases  of  sexual  hyperaesthesia.  Thus  Caspar2  recom- 
mends cold  baths,  followed  by  cold  douches  to  the  spinal 
column ;  also  cold  rubbing  with  wet  towels.  Prolonged  warm 
baths  have  a  calmative  effect  on  the  nervous  system  in  cases  of 
satyriasis  and  nymphomania.  Concerning  the  use  of  sponge-, 
shower-,  and  douche-  baths,  and  hip-,  steam-,  and  sea-  baths, 
compare  Gyurkovechky,3  Beard,4  Lowenfeld,5  and  Winternitz.6 

1  For  description  of  mechanical  means  for  the  prevention  of  masturbation,  compare 
Fournier,  De  1'onanisme,  Paris,  1875.  This  author  gives  a  long  list  of  devices;  for  ex- 
ample,— shirts  that  are  closed  in  various  ways,  trousers  or  drawers  without  openings,  etc. 
Mantegazza,  Fournier,  and  Porro  recommend  the  subcutaneous  insertion  of  a  ring  in  the 
prepuce  (near  the  frenulum).  The  wound  heals  and  the  ring  is  allowed  to  remain. 
Mechanical  irritation  causes  tension  at  the  base  of  the  glans,  and  gives  rise  to  pain. 
Inflammatory  oedema  follows  attempts  at  onanism,  and  attracts  the  attention  of  the 
parents.  According  to  Mantegazza,  the  ring  is  applicable  to  girls.  Here  the  ring  must 
be  inserted  between  the  middle  and  superior  third  of  the  labia  majora,  so  that  the  labia 
are  brought  in  contact  with  each  other  by  the  ring  at  the  point  indicated.  Compare 
Mantegazza,  Die  Hygiene  der  Liebe,  3  Aufl.,  Jena,  Costenoble,  p.  82.  But  no  mechanical 
devices  can  overcome  psychical  onanism. 

*  Caspar,  Impotentia  et  sterilitas  virilis,  Munchen,  1890,  p.  104. 

*  Loc.  cti.,  pp.  158,  160. 
4  Sexual  Neurasthenia. 

•  Loc.  ctf.,  p.  154. 

•  Die  Hydrotherapie,  1879,  Bd.  ii. 


44  SEXUAL   HYPER^ESTHESIA. 

Too,  treatment  with  sounds,  injections,  rectal  treatment,  and, 
in  females,  irrigations  and  other  local  applications,  may  be 
necessary. 

Various  forms  of  application  of  electricity  in  the  con- 
ditions which  result  from  onanism,  especially  neurasthenia,  are 
highly  recommended  by  all  authors  in  the  form  of  faradiza- 
tion as  well  as  of  central  galvanization  (Beard  and  Lowenfeld). 
Almost  every  author  has  his  own  method,  which  may  be  learned 
by  consulting  the  special  works.  Moll's  work,1  which  lately 
appeared  ("  Is  Electro-Therapeutics  a  Scientific  Remedial  Pro- 
cedure I "),  should  be  consulted ;  and  also  the  controversy  of 
Mobius  and  Eulenburg2  concerning  the  role  of  suggestion  in 
the  application  of  electricity.  Moll  declares  that,  though  he 
does  not  regard  electro-therapeutics  as  a  scientific  remedial  pro- 
cedure, it  is  still  the  physician's  duty,  even  though  it  be  based 
only  on  empiricism,  to  use  electricity  in  appropriate  cases. 

Among  the  articles  of  the  materia  medica,  the  various 
preparations  of  bromine  have  a  calmative  effect  upon  the 
genito-urinary  system.  Other  known  anaphrodisiacs  are:  bel- 
ladonna, lupulin,  camphor,  opiates,  and  salicylic  acid  with  pro- 
longed use.  On  the  other  hand,  cantharides,  phosphorus,  and 
atropine  exert  an  exciting  effect  on  the  genitals ;  and  for  this 
purpose  Hammond 3  recommends  strychnia. 

Psychical  Treatment  in  the  Non-Hypnotic  State. — In  the 
last  part  of  this  section  we  come  to  psychical  treatment  in 
general,  in  so  far  as  it  has  not  been  considered  with  reference  to 
sexual  hygiene,  and  to  therapeutic  suggestion  in  its  strict  sense 
as  the  most  important  part  of  it.  All  authors  that  have  written 
on  onanism,  sexual  neurasthenia,  etc.,  agree  concerning  the 
effect  of  psychical  treatment.  In  the  non-hypnotic  state,  with 
due  consideration  of  the  individual  concerned,  such  treatment 
must  first  be  in  the  direction  of  an  explanation  to  the  patient 
of  the  nature  and  the  results  of  his  disease.  To  convince  the 
patient  that  he  or  she  has  become  the  victim  of  an  abnormal, 

1  Berliner  KHnik,  Heft  41,  November,  1891. 
3  Berliner  klin.  Wochenschrift,  1892,  No.  8. 
*  Loc.  cit. 


ABNORMAL  INTENSIFICATION   OF   SEXUAL   DESIRE.  45 

dominating  impulse,  whether  an  onanist  or  a  nymphomaniac, — 
that  is,  self-knowledge, — constitutes  an  important  step  toward 
improvement.  The  mistrust  of  the  patient  is  to  be  removed 
and  his  hope  awakened  by  analyzing  his  case  for  him.  All 
exciting  influences,  like  obscene  reading,  bad  company,  por- 
nographic pictures,  etc.,  capable  of  exerting  a  detrimental  influ- 
ence on  the  patient's  imagination,  must  be  avoided.  An  attempt 
must  be  made  to  win  the  entire  confidence  of  the  patient,  to 
strengthen  his  self-reliance,  and  to  overcome  his  erroneous  ideas 
by  repeated  explanations  and  educational  means.  The  patient 
must  learn  to  control  himself,  to  strengthen  his  will,  and,  by 
practice,  gradually  become  master  of  his  sexual  impulses.  The 
diversion  of  his  attention  plays  a  role  the  value  of  which  should 
not  be  underestimated.  Experience  teaches  that  mere  diversion 
of  the  mind,  even  during  coitus,  may  overcome  erection.  Cases 
of  impotence  due  to  mental  preoccupation  are  not  very  infre- 
quent ;  it  occurs  with  especial  frequency  as  a  result  of  intense 
thought  on  abstract  subjects.  Broussais l  asserts  that  mathe- 
matical studies  diminish  sexual  power.  Grimaud  de  Coux2  and 
Martin  Saint-Ange  recommended  the  study  of  mathematics  as 
one  of  the  most  effectual  means  of  repressing  intense  libido 
sexualis.  These  authors  report  a  case  in  which  a  celebrated 
mathematician  was  always  restrained  from  completion  of  the 
act  of  coitus  by  the  sudden  recurrence  in  his  mind  of  problems 
of  geometry  or  proportion  with  which  he  had  been  occupied 
during  the  day.  Hammond3  reports  the  same  thing  in  the 
case  of  a  card-player  who,  during  cohabitation,  always  was 
seized  with  the  thought  of  a  technical  manipulation  of  cards, 
which  destroyed  his  sexual  power.  Active  business  operations 
make  a  large  demand  upon  thought,  and  thus  the  sexual 
impulse  is  repressed. 

Rosen  thai4  and  Bernheim 5  speak  in  favor  of  the  "larvated" 
form  of  psycho-therapeutics  in  the  non-hypnotic  state  and  for 

1  Cours  de  phr6nologie,  Paris,  1826,  p.  783. 

•  Histoire  de  la  g6n6ration  de  I'homme,  Paris,  1847,  p.  294. 
1  Zoc.  ctf . 

*  "  Ueber  psychische  Therapie  innerer  Krankheiten,"  Berliner  Klinik,  No.  25, 1890. 
'Neue  Studien  fiber  Hypnotismus,  etc.,  Wien,  1892. 


46  SEXUAL   HYPER^STHESIA. 

that  form  which  excites  pain.  Such  forms  depend,  for  their 
effect,  upon  the  excitation  of  ideas  of  cure,  by  means  of  intense 
sensory  impressions,  such  as  cold  douches  to  the  genitals,  faradic 
penciling,  or  other  instrumental  procedures,  and  fright  and  fear 
(with  children).  The  means  used  may  be  medical,  mechanical, 
electrical,  and  religious1  and  mystical.  The  patient's  thought 
with  regard  to  the  cure  should  be  altered.  The  patient,  though 
seemingly  passively,  in  reality  brings  about  the  cure  actively. 
A  quiet  demeanor  on  the  part  of  the  physician  that  invites  the 
confidence  of  the  patient,  an  understanding  of  the  latter's  in- 
dividuality, and  great  patience  are  indispensable. 

The  principal  means  of  psycho-therapeutics,  in  the  non- 
hypnotic  state,  seem  to  gain  more  and  more  recognition, 
especially  among  such  investigators  as  undervalue  the  effects 
of  hypnotic  procedures.  The  various  mechanical  and  other 
remedial  procedures,  above  alluded  to,  may  unconsciously  (with- 
out the  knowledge  of  physician  or  patient)  exert  a  suggestive 
influence, — a  statement  which  the  effect  of  the  measures  them- 
selves does  not  controvert.  Lowenfeld2  believes  that  quinine, 
iron,  arsenic,  and  the  bromides,  as  remedial  agents  in  obstinate 
cases  of  nervous  weakness  (of  sexual  origin),  are  effectual  for 
the  most  part  through  suggestive  effect;  and  he  recommends 
static  electricity  as  an  excellent  means  of  inducing  psychical 
effects. 

In  the  various  forms  of  psycho-therapeutics,  psycho- therapy 
by  suggestion  forms  the  most  effectual  remedial  measure.  It 
fulfills  all  the  requirements  of  such  treatment,  and  gains  a  more 
speedy  and  surer  entrance  into  the  patient's  mind  than  is  pos- 
sible to  any  of  the  other  forms.  Therefore,  it  may  be  regarded 
as  an  abridged  and  condensed  procedure  possessing  all  the 
advantages  of  psycho-therapeutics.  With  von  Krafft-Ebing, 
among  the  authors  repeatedly  mentioned  in  this  work,  Caspar3 

1  There  Is  no  doubt,  in  spite  of  numerous  exceptions,  that  a  strict  religious  educa- 
tion with  many  persons  is  an  excellent  prophylactic  against  sexual  errors.  Compare  the 
brochures  of  Romer,  previously  mentioned. 

*  Loc.  ctt.,p.  152. 

1  Loc.  cit.,  p.  98  :  "I  doubt  not  that  suggestive  therapy  (in  impotence  and  sexual 
disturbances)  will  give  invaluable  results." 


ABNORMAL   INTENSIFICATION    OF   SEXUAL   DESIRE.  47 

and  Lowenfeld1  principally  speak  in  favor  of  hypnotic  sugges- 
tion in  sexual  neuroses. 

Tessie's 2  remarkable  experiment  shows  that  erotic  feelings 
can  be  awakened  and  removed  by  hypnotic  suggestion.  To  an 
hypnotized  subject  he  suggested :  "  The  right  ring-finger  repre- 
sents lust ;  the  left,  chastity.  He  awakened  the  patient  with- 
out speaking,  and  then  pinched  the  right  ring-finger.  At  this 
the  patient  gradually  became  erotic,  and  he  overcame  the  feeling 
by  pinching  the  left  ring-finger.  Tessie  forgot  to  remove  this 
suggestion.  The  next  day  the  patient  presented  himself,  worn 
out  and  scarcely  able  to  stand.  The  patient  stated  that  the 
preceding  day  he  met  a  friend  who  pressed  his  right  hand,  and 
a  few  minutes  afterward  he  was  taken  with  an  overmastering 
desire  for  coitus.  He  noticed  that  this  desire  arose  from  the 
right  ring-finger,  which  he  had  pressed  many  times  during  the 
twenty-four  hours.  Excited  by  this  means,  he  had  practiced 
onanism  several  times  and  had  coitus  several  times  during  the 
night ;  and  on  the  day  on  which  he  came  to  Tessie  he  had  had 
several  ejaculations,  for  on  the  way  he  had  pressed  his  right 
ring-finger." 

The  physiological  basis  of  therapeutic  suggestion  in  hyper- 
sesthesia  sexualis  is  demonstrated  by  those  experiments  that 
show  the  possibility  of  voluntarily  increasing  and  diminishing 
by  suggestion  vasomotor  and  secretory  processes,  as  well  as  emo- 
tions, impulses,  and  mental  affects.  Dreams  of  a  sexual  con- 
tent, which,  as  is  well  known,  may  induce  ejaculations,  may  be 
called  physiological  auto-suggestions,  and  are  analogues  of  the 
suggested  dream  in  hypnosis. 

Notwithstanding  the  insufficiency  of  the  material  at  hand, 
the  collection  of  previous  experiences  answers  this  question  in 
the  affirmative. 

1  Loc.  cit.,  p.  157  :  "  In  hypnotizable  persons  hypnotic  suggestion  is  capable  of  the 
greatest  service.  In  the  case  mentioned  above,  of  a  girl  who,  after  abandoning  masturba- 
tion that  had  been  long  practiced,  suffered  with  occasional  sleeplessness  and  greater  sexual 
excitability,  a  single  hypnosis  with  appropriate  suggestions  was  repeatedly  successful  in 
giving  sleep  and  freedom  from  sexual  excitement  for  weeks  at  a  time.  Still,  this  patient 
was  an. excellent  somnambulist,  who  could  be  placed  in  deep  hypnosis  in  a  few  seconds. 
In  other  cases  in  which  only  slighter  degrees  of  hypnosis  could  be  secured,  the  results  were 
not  so  brilliant." 

'La  France,  1889,  p.  109,  cited  by  Caspar,  loc.  cit.,  p.  99. 


48  SEXUAL   HTPER^STHESIA. 

Charles  Richet1  demonstrated  that  it  is  possible  to  induce 
ejaculation  by  merely  awakening  a  belief  that  coitus  is  being 
performed.  Sexual  psycho-pathology,  in  ideal  cohabitation,  pre- 
sents analogous  examples  of  orgasm  induced  by  auto-suggestion. 
Merely  the  direction  of  the  attention  to  the  performance  of 
coitus,  in  association  with  lively  images  of  sexual  content, 
induces  vaso motor  changes  in  the  genitals,  as  any  one  may 
demonstrate  on  himself.  Purely  as  a  result  of  idea,  excitation 
of  the  dilators  of  the  penis  occurs,  exactly  in  the  manner  that 
blushing  and  pallor  are  brought  about  by  psychical  impressions. 

While  without  hypnosis  the  vasomotor  nerve-centres  may 
be  intensely  influenced  by  ideas,  in  hypnosis  there  is  a  marked 
increase  in  the  intensity  of  this  physiological  manifestation, 
which  may  attain  overpowering  force.  This  occurs  as  a  result 
of  the  removal  or  weakening  of  the  regulating  inhibitory  mech- 
anisms,— associative  and  opposing  ideas.  Natural  reaction, 
i.e.,  the  transformation  of  idea  into  a  certain  form  of  movement, 
may  take  place  with  more  energy  and  rapidity.  Vasomotor 
effects  induced  by  suggestion  may,  in  certain  persons,  become 
so  intense  as  to  cause  hemorrhages,  menses,  etc.  Forel2  shows 
that  it  is  possible  to  induce  and  prevent  erection  by  suggestion, 
and  that  thus  pollutions  may  be  controlled.  In  the  same  way, 
the  well-known  physiological  fact  of  the  waking  state  that 
simply  ideas,  feelings,  and  impulses  call  up  desires  or  inhibit 
them, — e.g.,  appetite  (at  sight  of  food),  thirst,  joy,  excitation  of 
libido  sexualis  at  sight  of  a  woman,  etc., — is  intensified  in  hyp- 
nosis. In  an  hypnotized  woman  I  was  able  to  induce  the 
greatest  expressions  of  joy  by  suggestion,  and  at  the  height  of 
the  emotion  change  it  by  the  same  means  to  the  opposite  ex- 
treme of  feeling,  i.e.,  to  sadness  with  passionate  weeping.  In  a 
similar  manner,  we  may  affect  the  psychical  part  of  the  sexual 
mechanism  more  easily  and  enduringly  in  hypnosis  than  in  the 
waking  state. 

The  memory-pictures,  which  in  all  psycho-sexual  patients 
are  influential  in  inducing  sexual  feelings,  may  be  weakened  in 

1  Moll,  Der  Hypnotismus. 

a  Forel,  Hypnotismus,  2  Aufl.,  Enke,  Stuttgart,  1891,  p.  56. 


ABNORMAL   INTENSIFICATION   OF   SEXUAL   DESIRE.  49 

their  effect  or  rendered  impotent  by  suggestion.  In  onanists, 
for  example,  we  may  successfully,  suggest  repentance  and  open 
confession  (e.g.,  in  hypnosis  to  control  the  statements  made  in 
the  waking  state),  and  thus  successfully  oppose  their  weakness 
of  will,  in  so  far  as  it  does  not  arise  from  deep,  inherited  consti- 
tutional conditions.  The  impulse  to  self-abuse,  or  the  patho- 
logical impulse  to  homo-sexual  intercourse,  may  have  become 
a  habit  which  imperatively  and  unconsciously  controls  the 
patient,  he  being  unable  to  resist  it.  In  such  cases  we  must 
strive  to  combat  the  pathological  auto-suggestion  in  accordance 
with  its  manner  of  origin,  for  habit  is  to  be  regarded  as  auto- 
suggestion. The  ideational  excitant  imparted  in  therapeutic 
suggestion  must  be  intensified  by  repeated  hypnotization,  until 
it  acts  automatically  from  the  brain  and  has  become  a  habit. 
Through  consequent  discipline  it  finally  becomes  a  habit  having 
the  same  force  as  the  pathological  auto-suggestion,  and  thus 
compensates  the  central  pathological  excitant.  Unfortunately, 
hereditary  disposition  sets  a  limit  here  also  which  therapeutic 
efforts  cannot  pass.  In  correct  and  skillful  use  of  ideas  induced 
in  hypnosis  lies  the  power  of  suggestion  as  a  pedagogic  aid.  In 
the  same  way  we  are  able  to  effectually  combat  the  pathological 
results  which  manifest  themselves  in  neurasthenic  symptoms  and 
alterations  of  the  normal  subjective  feeling. 

The  nearer  the  anomaly  approaches  actual  mental  disease, 
the  more  difficult  the  physician's  task  becomes.  The  disturb- 
ance of  attention  makes  hypnosis  impossible,  and  the  influence 
of  the  operator,  Unfortunately,  is  not  always  sufficient  to  equal 
the  power  of  the  auto-suggestions  which  in  many  patients  arise 
from  organic  conditions.  As  we  have  seen  from  the  foregoing 
consideration,  the  ideas  implanted  in  the  brain  during  hypnosis 
correct  the  disturbances  of  the  sexual  life,  the  causes  of  which 
in  a  great  number  of  cases  are  psychical,  and  the  secondary 
results  of  which  manifest  themselves  in  symptoms  of  functional 
weakness  of  the  nervous  system ;  or  the  psychical  factors  play 
the  principal  role  in  the  disease.  In  comparison  with  other 
indirect  remedial  measures,  we  may  characterize  therapeutic 
suggestion  in  manifestations  of  sexual  hyperaesthesia  from 


50  SEXUAL   HYPER.ESTHESIA. 

psychical  causes  as  the  most  direct  remedial  measure,  and  one 
which  attacks  the  evil  at  its  root.  In  cases  of  onanism  no 
other  method  of  treatment  can  be  compared  with  therapeutic 
suggestion  in  rapidity  and  certainty  of  action ;  psychical  thera- 
peutics in  the  waking  state  often  does  not  succeed  where  hyp- 
notic suggestion  is  successful.  Since  onanists  are,  as  a  rule, 
children,  it  is  very  easy  to  see  that  the  categorical  command  of 
the  suggestive  impulse,  owing  to  their  sensitiveness  to  hypnosis, 
is  much  more  effectual  than  the  circumstantial  procedure  in  the 
waking  state.  Besides,  the  latter  method,  in  the  matter  of  self- 
knowledge,  strength  of  will,  etc.,  makes  demands  upon  the 
juvenile  mind  which  reach  beyond  the  mental  horizon  and 
ability  of  many  children.  After  these  theoretical  considerations 
there  can  no  longer  be  any  doubt  that  psycho-therapeutics  by 
suggestion  is  destined  in  the  future  to  play  the  principal  role  in 
the  treatment  of  onanists,  while  former  methods  of  treatment 
are  to  be  employed  only  for  the  sake  of  completeness. 

In  a  more  limited  sense,  the  same  is  true  of  satyriasis  and 
nymphomania  in  their  milder  forms ;  severe  cases  and  those 
due  to  organic  conditions  are  to  be  treated  in  asylums  as  cases 
of  insanity,  where  in  such  cases  suggestion  may  also  possibly 
prove  of  benefit.  Practical  experience  fully  confirms  our  opinion 
based  on  pathogenesis. 


CHAPTER   III. 

CASES   ILLUSTRATING   THE   SUGGESTIVE   TREATMENT 
OF    SEXUAL   HYPER^ESTHESIA. 

TWENTY  cases  from  the  experience  of  others  and  myself 
follow,  which,  with  the  exception  of  Case  9,  are  published 
together  for  the  first  time  from  the  manuscripts  of  the  authors. 
The  grouping  of  the  cases  corresponds  with  the  foregoing 
classification, 

ONANISM  BY  MEANS  OP  TACTILE  IRRITATION. 
(Cases  1  to  16, — 1  to  9  by  other  authors ;  10  to  16  by  the  author.) 

Case  1.  Onanistic  Inclinations  in  a  Child  Overcome  by  Hypnotic  Sug- 
gestion, without  Relapse.  Reported  by  Dr.  Liebeault,  Nancy. —  L.,  a  boy 
aged  3,  in  July,  1887,  was  cured  of  his  onanistic  inclinations  in  three 
sittings.  He  passed  into  light  sleep.  In  September,  1888,  relapse.  I 
cured  him  of  his  vice  by  suggestion  in  eight  sittings.  According  to  his 
grandfather's  statement,  there  has  since  been  no  relapse. 

Case  2.  Onanism  in  a  Boy  Cured  by  Hypnotic  Suggestion.  Reported 
by  Dr.  Liebeault. — Another  boy,  aged  7,  passed  at  once  into  somnambu- 
lism, and  in  five  sittings  was  cured  of  his  onanistic  tendencies.  He  has 
not  been  brought  for  treatment  again ;  hence,  I  hold  his  cure  to  be 
lasting. 

Case  3.  Masturbation  and  Enuresis  Nocturna  in  a  Girl  Cured  by 
Hypnotic  Suggestion.  Reported  by  Dr.  Liebeault. — A.,  aged  8,  female, 
masturbated  by  touching  the  genitals  with  her  hands  from  early  child- 
hood, and  suffered  with  enuresis  nocturna.  After  three  hypnotic  sittings 
(somnambulism)  the  evil  habit  and  the  enuresis  disappeared.  Has  she 
relapsed?  I  have  heard  nothing  of  it.  Still,  to  avoid  relapse  in  such 
obstinate  cases,  from  time  to  time  they  should  be  treated  by  hypnosis  as 
a  prophylactic  measure. 

Case  4.  Onanism  and  Chorea  Improved  by  Suggestion.  Reported  by 
Dr.  Liebeault. — X.,  a  boy  aged  9,  was  seduced  to  onanism  by  an  old  woman. 
He  was  also  subject  to  choreiform  movements.  Suggestive  treatment 
improved  him  from  sitting  to  sitting.  Unfortunately,  the  treatment  was 
interrupted,  and  I  could  not  learn  whether  he  was  completely  cured. 

Case  5.  Unsuccessful  Hypnotic  Treatment  of  a  Weak-minded  Onan- 
ist.  Reported  by  Dr.  Liebeault. — B.,  a  young  man  aged  30,  became  we.ik- 
minded  at  the  age  of  12,  and  had  masturbated  for  years.  In  spite  of  all 

(51) 


52  SEXUAL   HYPER^STHESIA. 

treatment,  he  continued  the  vice.  At  the  first  attempt  at  hypnosis  he 
passed  into  deep  sleep.  Notwithstanding  the  fact  that  for  months  I 
daily  subjected  him  to  treatment  by  suggestion,  I  obtained  no  result. 

Case  6.  Masturbation  in  a  Girl  Cured  by  Suggestion.  Reported  by 
Dr.  Wetter  strand,  Stockholm.  —  A  girl  aged  26,  school-teacher  from  the 
province,  was  given  to  masturbation  from  childhood.  In  three  weeks  of 
treatment  she  was  cured  by  hypnotic  suggestion.  W.  could  not  ascer- 
tain whether  she  had  since  married. 

Case  7.  Temporary  Improvement  by  Hypnotic  Suggestion  in  a  Boy, 
Predisposed  by  Heredity,  Suffering  with  the  Habit  of  Onanism.  Reported 
by  Dr.  Bernheim,  Nancy.  —  A  child  aged  about  8,  Russian,  was  brought 
to  me  by  his  mother  three  years  ago.  The  boy  had  masturbated  for 
years.  This  tendency  was  probably  hereditary  ;  for,  as  a  mature  man, 
his  father  was  unable  to  overcome  this  evil  habit.  The  child  was  pale, 
seemed  lymphatic  and  nervous,  and  had  been  badly  trained.  It  was 
easy  to  produce  hypnosis  deep  enough  to  leave  no  memory  of  it  after 
waking.  But  during  the  hypnosis  he  threw  and  turned  himself  about. 
Quieting  suggestions  were  without  effect.  I  treated  him  three  or  four 
weeks  continuously.  During  this  time  he  seemed  to  have  abandoned  his 
habit;  at  least,  his  mother,  who  watched  him  carefully,  noticed  nothing. 
But  after  interruption  of  the  treatment  he  renewed  his  habit.  All 
medical,  hygienic,  and  other  treatment  remained  futile. 


Case  8.  Lasting  Removal  of  Habitual  Onanism  by  Hypnotic 
gestion  in  a  Boy.  Reported  by  Dr.  Bernheim.  —  X.,  aged  8,  a  pupil  at 
Bar-le-Duc,  was  brought  to  me  by  his  father,  April  9,  1891,  on  account 
of  habitual  onanism,  which  he  had  practiced  for  three  years.  A  boy 
of  16  had  taught  it  to  him.  Seven  months  previously  his  parents  had 
discovered  his  vice.  They  surprised  the  child  inflagranti,  while  he  was 
apparently  sleeping  in  bed.  The  boy  masturbated  as  often  as  five  times 
in  a  night;  as  a  rule,  three  times,  and  as  often  during  the  day.  Ejacu- 
lation began  in  the  preceding  October.  Many  methods  of  treatment 
had  been  tried  (bromides,  threats,  baths,  removal  of  all  excitement,  etc.). 
For  three  months  he  had  drunk  only  water.  Nothing  had  been  success- 
ful. The  child  seemed  very  intelligent,  obedient,  and  well  trained.  For 
two  months  it  had  been  noticed  that  his  mental  powers  were  failing. 
Since  then  he  had  not  been  sent  to  school  ;  for,  in  spite  of  the  watchful- 
ness of  the  teacher,  he  masturbated.  Still,  the  patient  had  a  desire  to 
be  cured.  But  the  passion  was  stronger  than  his  will,  which  was  power- 
less. According  to  his  statement,  the  act  was  performed  in  sleep  at 
night  involuntarily.  Whenever  he  desired  to  enter  the  closet,  he  re- 
quested his  father  to  accompany  him,  since,  otherwise,  he  could  not  with- 
stand the  temptation  to  masturbate.  Aside  from  rotheln  and  scarlet 
fever,  X.  had  had  no  diseases.  He  had  never  shown  symptoms  of  nerv- 


ONANISM   BY   MEANS   OF   TACTILE   IRRITATION.  53 

ousness,  and  was  devoid  of  nervous  heredity.  At  the  first  sitting,  on 
April  9th,  I  placed  him  in  deep  sleep,  with  amnesia  on  awaking.  I  sug- 
gested to  him  that  neither  by  day  nor  by  night  was  he  to  have  a  thought 
of  touching  himself,  and  that  he  would  be  able  to  withstand  all  tempta- 
tion. I  repeated  these  suggestions  every  day  until  the  23d  of  April. 
From  the  first  sitting  the  child  continued  cured.  The  thought  to  mas- 
turbate did  not  occur  again  (according  to  his  own  statement).  April 
llth  he  weighed  44£  pounds;  on  April  13th,  45-}-;  April  16th,  46 -f; 
April  21st,  47  -)-•  Before  his  departure,  I  suggested  to  him  to  write  me 
concerning  the  duration  of  his  cure.  I  received  a  letter  dated  May  23d. 
The  cure  remained  lasting.  At  that  time  he  had  gained  slightly  in 
weight.  Some  months  later  I  met  the  family  physician.  According  to 
his  statement,  the  cure  had  continued  lasting.  The  child,  previously 
shy,  and  who  would  never  look  at  the  doctor,  then  met  him  without 
embarrassment,  with  open  mien  and  a  good  conscience. 

Case  9.  Moral  Perversity  (and  Onanism)  Cured  by  Hypnotic  Sug- 
gestion. Reported  by  Dr.  Aug.  Voisin?  Paris. — A  boy,  aged  16,  was 
brought  to  me  June  9,  1888,  with  the  desire  that  I  cure  him  of  evil 
instincts  by  hypnotism.  At  the  age  of  13  he  had  tetanus.  Since  that 
time  he  had  suffered  with  nystagmus  and  had  stuttered ;  but  before  that, 
and  since  his  sixth  or  seventh  year,  his  evil  peculiarities  of  character 
had  made  him  unendurable.  He  lied,  stole,  was  disobedient  and  vicious. 
His  evil  instincts  had  grown  worse  from  year  to  year.  In  several  schools 
he  could  not  be  endured.  All  efforts  of  his  mother  to  improve  him  were 
vain.  It  was  impossible  to  get  him  to  take  the  first  communion.  Of 
late  years  he  had  stolen  more  frequently,  and  led  a  vicious  life.  He 
stole  from  his  mother  in  order  to  run  after  girls.  Onanism  in  him  was  a 
passion  to  which  he  gave  himself  in  the  same  room  with  his  mother 
without  shame.  He  imagined  that  he  loved  evil,  and  stated  that  he  felt 
no  remorse.  His  parents  Consulted  a  great  number  of  teachers  and 
priests  without  effect. 

The  discipline  of  the  houses  of  correction  was  too  weak  for  him. 
Finally,  I  was  consulted  in  the  matter. 

At  the  first  examination,  the  existence  of  convergent  strabismus  of 
the  left  eye,  nystagmus,  and  stuttering  was  ascertained.  Ears,  hands, 
and  feet  normal.  No  tumefied  glands ;  no  bronchocele.  The  tongue  was 
deflected  to  left  when  protruded.  He  read  only  with  difficulty,  and  had 
but  an  elementary  knowledge  of  geography.  Memory  good,  on  the  whole. 

June  9th,  first  hypnotic  treatment.  Fixation  of  a  shining  ball  that 
was  hung  over  his  head,  in  connection  with  sleep-suggestions,  induced 
hypnosis  in  the  fifth  sitting.  After  the  occurrence  of  sleep  I  began  to 
combat  the  tendency  to  steal  and  to  change  his  character  by  suggestion. 

1  Dr.  Aug.  Voisin,  M6dicin  de  la  SalpStriere,  "  Un  cas  de  perversity  morale  gu£ri 
par  la  suggestion  hypnotique,"  Revue  de  1'bypnotisme,  1888,  p.  130. 


54  SEXUAL   HYPER^ESTHESIA. 

After  the  first  sitting  he  ceased  to  steal,  and  his  character  underwent  a 
favorable  change.  The  treatment  was  continued  every  third  day,  and 
the  suggestions  were  directed  in  turn  against  his  vicious  character,  his 
evil  instincts,  onanism,and  his  immoral  habits. 

July  6th  the  young  man  was  like  a  different  person.  All  thought 
of  doing  evil  had  disappeared  and  given  place  to  the  best  principles. 
His  disobedience  and  incorrigibility  gave  place  to  a  desire  to  be  pleasant 
to  his  mother.  So  to  speak,  he  was  no  longer  the  same  young  man,  and 
he  expressed  to  me  his  delight  at  the  change. 

On  October  20th,  after  absence  of  six  weeks,  the  cure  continued, 
though  there  had  been  no  treatment  in  the  interval. 

The  further  continuance  of  the  cure  and  the  fact  of  a  complete 
inner  transformation  were  confirmed  by  a  letter  to  Dr.  Voisin,  based 
upon  observation,  which  was  written  by  a  former  teacher  of  the  patient 
after  his  discharge. 

The  foregoing  case  seems  to  me  worthy  to  be  reported,  because  the 
onanistic  tendencies  are  to  be  regarded  as  a  symptom  of  the  boy's  char- 
acter. With  the  successful  and  lasting  change  of  character  the  root  of 
the  evil  was  removed.  This  remarkable  result  offers  hope  to  such 
unfortunates  in  whom  masturbation  is  favored  by  hereditary  predis- 
position. 

Case  10.  Personal  Observation.  Successful  Hypnotic  Treatment  of 
an  Onanist  in  Three  Sittings. — V.,  aged  14,  pupil  of  a  foreign  school, 
was  sent  to  me,  April  20,  1889,  with  a  letter  from  his  mother.  Parents 
healthy;  V.  had  had  no  severe  illnesses;  moderate  left  inguinal  hernia; 
truss.  Genitals  normally  developed.  Patient  is  suspected  of  masturba- 
tion, and  after  rigid  questioning  he  confessed  his  vice.  For  a  year  or  two 
he  had  practiced  it  frequently  (seduced  to  it).  Unfavorable  effect  on 
the  nervous  system.  Remarkable  and  increasing  dullness  in  school. 
Sleepy,  inattentive,  dreamy,  etc. 

During  his  stay  of  nine  days  in  Munich  the  patient  could  be  hypno- 
tized only  three  times, — on  April  22d,  24th,  and  27th.  He  passed  into 
somnambulism  ;  suggestions  to  remove  his  vice.  During  the  treatment 
the  patient  made  no  attempt  to  masturbate.  He  stated  that  he  felt  dis- 
gust, and  promised  me  repeatedl}"  to  masturbate  no  more. 

April  28th  he  returned  to  school.  After  the  three  sittings  I  could 
only  discharge  the  patient  as  improved,  the  more  because  it  was  clear 
that  the  unavoidable  stimulus  of  seduction  would  still  influence  him.  I 
called  the  attention  of  his  relatives  to  the  probability  of  relapse,  and 
explained  that  a  perfect  cure  might  be  obtained  by  frequent  regular 
repetition  of  the  procedure,  together  with  strict  control  of  the  patient. 

In  September,  1891,  I  learned  that  further  treatment  of  the  patient 
for  his  vice  had  not  been  necessary.  Influenced  by  the  psychical  treat- 
ment in  1889,  probably,  he  had  entirely  abandoned  the  evil. 


ONANISM   BY    MEANS   OF    TACTILE   IRRITATION.  55 

Case  11.  Personal  Observation.  Temporary  Improvement,  Lasting 
Six  Months,  of  an  Onanist  by  Hypnotic  Treatment. — Patient  aged  18, 
without  hereditary  or  pathological  antecedents.  Given  to  onanism  since 
his  thirteenth  year ;  masturbates  daily,  usually  mornings.  He  rises  late, 
has  no  desire  to  work,  and  suffers  with  pressure  in  the  head  and  pain  in 
the  back.  Dreamy ;  memory  weak.  He  had  fallen  behind  in  school. 
Depressed  state  alternating  with  causeless  intense  excitement  (violent 
outbursts  of  anger).  Patient  was  first  hypnotized  on  February  18, 1889. 
Complete  hypotaxis.  Cataleptic  symptoms.  Energetic  suggestions  to 
give  up  the  abnormal  impulse  and  satisfy  his  desires  with  women.  Up 
to  March  llth,  masturbation  but  once  (previously  daily). 

Gonorrhoea  from  second  coitus,  which  was  cured  by  injections  and 
bougies  in  the  course  of  the  following  weeks.  Up  to  M&y  20th  the 
patient  was  hypnotized  twenty-six  times,  at  first  daily,  then  two  or  three 
times  a  week,  and  finally  every  week  or  fortnight. 

On  May  20th  the  patient  was  discharged  as  essentially  improved. 
The  complaint  mentioned  had  disappeared  entirely  of  late.  Mood  agree- 
able. No  ouanistic  relapses,  but  from  time  to  time  normal  cohabitation. 
He  stated  that  family  circumstances  made  it  very  difficult  for  him  to 
satisfy  his  libido  regularly.  After  six  months  the  patient  reported  that 
he  was  well.  On  my  last  inquiry  (two  years  after)  he  reported  that  he 
had  relapsed. 

This  relapse  cannot  alter  the  fact  that  a  decided  improvement  was 
brought  about  by  the  treatment  in  1889.  If  the  patient  and  his  relatives 
did  not  take  pains  to  carry  out  proper  sexual  hygienic  measures  and 
provide  prolonged  medical  control,  the  relapse  can  only  be  ascribed  to 
this  failure ;  the  result  of  therapeutic  suggestion  is  not  altered  by  it. 

Case  12.  Personal  Observation.  Lasting  Cure  of  an  Onanist  by 
Hypnotic  Suggestion,  and  his  Preparation  for  Examination  by  Suggestion. 
— B.  S.,  medical  student,  aged  20.  Parents  and  other  members  of  family 
healthy.  No  diseases  except  measles  and  chicken-pox  in  early  child- 
hood. Moderate  skolio-kj'phosis  due  to  rachitis  treated  surgically. 
Sexual  desire  began  in  his  twelfth  year;  gratification  of  it  since  that 
time  by  masturbation,  as  a  result  of  seduction.  Patient  had  never  felt 
the  need  of  hetero-sexual  intercourse.  Though  this  constituted  the  con- 
tent of  his  sexual  imagination,  he  had  never  had  the  courage  and  self- 
confidence  to  substitute  coitus  for  onanism.  The  patient  still  mastur- 
bated at  least  three  times  a  week.  For  a  long  time  S.  had  noticed  the 
injurious  effect  of  this  sexual  condition  upon  his  nervous  system.  Great 
inclination  to  dream,  languid  appearance,  retiring  habits,  anxiety.  Great 
lack  of  energy  and  diminution  of  mental  activity.  S.  often  remained  in 
a  doze  mornings  until  11  o'clock,  and,  as  a  rule,  rose  late.  Remarkable 
inattentiveness  and  mental  weakness,  which  had  made  itself  felt  very 
unpleasantly  in  the  preparatory  studies  he  was  making  in  the  face  of 


56  SEXUAL   HYPEILESTHESIA. 

his  approaching  medical  examination.  He  looked  forward  to  the  exam- 
ination with  anxiety,  convinced  that  he  could  not  pass  it.  The  patient 
was  very  easily  confused,  and  had  lost  self-confidence.  Great  timidity. 
He  consulted  me  not  about  his  onanism,  but  to  have  his  courage  and 
confidence  strengthened  for  the  examination  by  suggestion.  In  other 
respects  the  patient  presented  no  noteworthy  physical  or  mental 
abnormality. 

June  11,  1891,  first  hypnotic  attempt.  In  spite  of  unconscious 
resistance  to  the  suggestive  sleep,  in  a  few  minutes  he  passed  into  the 
second  stage  (Forel),  catalepsy,  with  inability  to  interrupt  it  voluntarily. 
Complete  hypotaxis,  but  consciousness  retained. 

Suggestions :  1.  Repugnance  for  onanistic  manipulations.  2.  In- 
clination for  coitus  and  complete  faith  in  its  successful  performance. 
3.  Indifference  about  the  result  of  the  examination  ;  perfectly-clear  head 
during  it,  and  the  presence  in  mind  of  knowledge  acquired.  4.  Post- 
hypnotic  feeling  of  well-being. 

June  18th  S.  joyfully  told  me  that  the  previous  day  he  had  ventured 
to  attempt  coitus  for  the  first  time,  and  had  succeeded  perfectly.  No 
thought  of  onanism  since.  Increased  self-confidence  and  belief  in  the 
cure. 

Repetition  of  the  treatment  and  suggestions  of  June  iTth. 

June  19th,  three  hypnotic  sittings.  No  onanistic  inclinations. 
Voluntarily  the  patient  gave  me  his  word  of  honor  that  he  would  never 
masturbate  again,  and  set  out  for  Austria  to  take  his  examination  at  a 
provincial  university. 

June  26,  1891,  he  wrote  in  a  letter:  "It  is  my  pleasant  duty  to 
inform  you  that  your  efforts  in  my  behalf  were  crowned  with  the  best 
results  to-day.  I  passed  my  examination  with  distinction.  For  this  I 
have  to  thank  only  your  excellent  application  of  suggestion;  for  what 
you  suggested  to  me  was  fulfilled  perfectly  :  I  had  a  clear  head  and  not 
the  confusion  which  had  previously  hindered  me  in  study  and  recapitula- 
tion of  what  I  had  learned.  Since  I  had  studied  much,  and,  owing  to 
the  suggestion,  was  certain  of  being  able  to  apply  what  I  had  acquired 
at  the  proper  place,  I  went  to  the  examination  with  a  feeling  of  indiffer- 
ence. By  such  a  result  my  faith  in  hypnotism  was  greatly  increased. 
As  for  my  former  vice,  I  can  assure  you  that,  since  I -had  the  honor  to 
be  treated  by  you,  I  have  not  masturbated  and  have  felt  no  desire  to  do 
so.  I  now  have  the  best  prospect  of  inducing  my  chamber-maid  to  accede 
to  my  desire.  We  kiss  each  other,  etc.  I  mention  this  merely  to  show 
you  that  in  this  direction  the  suggestion  has  had  the  greatest  success. 
With  very  kind  regards,  I  remain,  most  respectfully,  your  ever-grateful 
patient." 

Early  in  August,  S.  again  presented  himself.  He  had  not  mastur- 
bated again.  He  was  better  physically  and  mentally,  and  from  time  to 


ONANISM   BY   MEANS   OP   TACTILE   IRRITATION.  57 

time  was  accustomed  to  visit  the  demi-monde  to  gratify  his  lively  sexual 
desire.  I  think  I  may  regard  the  patient  as  cured  of  onanistic  ten- 
dencies. 

The  hypnotic  treatment,  owing  to  the  youth  of  the  patient,  under- 
taken sufficiently  early,  removed  in  only  three  sittings  the  fully-developed 
masturbatic  excesses  that  had  existed  for  seven  years.  Besides,  there 
was  the  remarkable  influence  of  suggestion  upon  the  mental  condition  of 
the  patient  during  his  examination. 

It  seems  very  questionable  whether  psychical  treatment  in  the 
waking  state  (which,  as  Rosenbach1  has  shown  in  his  instructive  work, 
must,  as  a  rule,  avail  itself  of  indirect  methods, — medicaments,  mechan- 
ical and  electrical  means)  would  have  been  attended  in  the  foregoing 
case,  in  the  same  brief  period,  with  a  similar  prompt  result.  To  over- 
come a  man's  one-sided  thought  and  feeling,  that  had  been  habitual  for 
seven  years,  by  means  of  awakening  hopeful  ideas  and  persuasion,  would 
at  least  be  much  more  tedious  than  to  remove  the  injurious  associations 
by  means  of  hypnotic  suggestion,  even  if  the  first  method  were  possible 
in  a  medically-educated  skeptic. 

Case  13.  Personal  Observation.  Successful  Suggestive  Treatment 
of  an  Onanist. — H.,  aged  24  ;  mother  gouty,  father  nervous.  A  paternal 
great-uncle  a  drinker;  other  members  of  family  healthy.  At  the  age  of 
8  patient  had  typhoid  fever,  and  was  nervous  after  it  for  two  j'ears.  The 
patient  learned  to  masturbate  as  a  result  of  itching  of  the  genitals 
induced  by  a  superficial  sore  on  the  prepuce.  Touch  induced  erection, 
and  further  friction  ejaculation.  The  patient  is  very  powerfully  built, 
tall,  and,  aside  from  phimosis,  presents  no  abnormalities  or  anomalous 
S3rmptoms. 

For  two  years  he  masturbated  daily,  and  during  the  act  thought  of 
coitus  with  a  lady  to  whom  he  was  attracted.  Masturbation  was  always 
accompanied  by  the  same  idea.  Unfavorable  effect  on  the  nervous  sys- 
tem. The  patient  likes  to  lie  abed  late  dozing.  Memory  and  understand- 
ing suffered.  Headache,  loss  of  energy,  depression,  irritability,  and 
pressure  in  back  of  head  were  added.  The  neurasthenic  troubles  hin- 
dered his  studies.  Since  learning  its  meaning,  onanism  was  less  frequent, 
at  times  only  three  or  four  times  a  week.  In  a  students'  societ\r  he  had 
taken  a  vow  of  chastity,  and  he  had  numerous  inward  struggles  between 
moral  thoughts  and  sensual  excitement. 

Owing  to  the  fact  that  his  ability  to  work  had  diminished  during  the 
last  two  months,  he  had  taken  an  antineurasthenic  hydropathic  cure,  by 
which  his  general  condition  had  been  improved.  But  his  onanistic  ten- 
dency is  unchanged.  During  the  last  week  he  had  masturbated  three 
times ;  pollutions  occurred  at  night  once  or  twice  a  week. 

1  Comp.  "  Ueber  psychische  Therapie  innerer  Krankheiten,"  Berliner  Klinik,  July, 
p.  23  (Fischer,  1890). 


58  SEXUAL   HYPER^ESTHESIA. 

On  the  evening  of  November  20th,  when  a  prostitute  addressed  him, 
his  sensual  excitement  overmastered  him  as  never  before,  overcame  his 
resolutions,  and  clouded  his  brain  ;  so  that,  as  if  "  drunk  or  in  a  dream," 
and  devoid  of  will,  he  followed  her  and  had  coitus  for  the  first  time. 
When  he  awoke  from  his  dream,  severe  self-accusation,  remorse,  fear  of 
infection.  On  the  morning  of  the  21st  H.  consulted  me  to  learn  whether 
he  had  been  infected.  The  psychical  impressions  left  by  the  events  of 
the  day  before  were  so  strong  that  at  the  examination  the  patient  sank 
into  a  chair,  almost  fainting  and  disheartened.  Encouraging  words  and 
explanation  of  the  sexual  relations  quieted  him  somewhat.  The  patient 
then  came  under  my  treatment,  which  consisted  of  three  measures : 
(a)  operation  for  phimosis ;  (6)  antineurasthenic  therapy  ;  (c)  removal 
of  onanistic  inclinations  by  suggestion. 

I  began  with  c  on  November  24th,  after  I  had  explained  matters  to 
the  patient,  considering  his  religious  convictions  and  scruples  of  con- 
science. The  duty  of  the  physician  required  him  to  warn  against  onan- 
ism ;  normal  intercourse  performed  with  prostitutes,  with  measures 
against  infection,  was  the  lesser  of  two  evils,  but  the  physician  had  no 
right  to  oppose  the  patient's  moral  principles  by  recommending  coitus. 
The  patient,  therefore,  must  struggle  against  his  sexual  instinct,  and  the 
struggle  could  be  lightened  by  hypnotic  suggestion  ;  if,  however,  the 
patient  could  not  thus  overcome  it,  coitus  was  to  be  preferred  to  mas- 
turbation. 

November  24th,  first  hypnotic  attempt.  Deep  somnolence  (stage 
II).  Imperfect  memory.  Suggestions  against  onanistic  thoughts  and 
depression.  Strengthening  of  self-confidence  and  resistive  power  by 
suggestion.  Excellent  result.  After  hypnosis  and  during  the  following 
days  the  patient  felt  well  and  had  no  inclinations  to  onanism.  Spirits 
raised. 

Repetition  of  the  procedure  on  November  28th  and  December  1st. 
The  patient  passed  at  once  into  somnambulism. 

December  30th,  operation  for  phimosis.  My  intention  to  perform  it 
during  hypnosis  was  not  carried  out,  because  the  patient  was  too  excited. 
In  all  the  patient  was  subjected  to  twelve  sittings ;  was  discharged 
toward  the  end  of  January,  1892,  as  cured.  Up  to  that  time  it  had 
been  unnecessary  for  him  to  repeat  coitus.  He  has  been  under  observa- 
tion, and  there  has  been  no  relapse  so  far. 

Case  14.  Personal  Observation.  Onanism  and  Neurasthenic  Troubles. 
Lasting  Cure  by  Suggestion. — N.,  aged  28.  Father  drinker,  uncle  and 
brother  contrary-sexual,  sister  hysterical.  Neuropathic  disposition  due 
to  hereditary  taint.  Patient  stated  that  since  his  twentieth  year  he  had 
had  pulmonary  haemorrhage  five  times.  Until  three  years  ago  he  had 
lived  abroad,  where  there  had  been  small  opportunity  for  hetero-sexual 
intercourse,  on  account  of  the  small  number  of  women  and  the  diseases 


ONANISM   BY   MEANS   OF   TACTILE   IRRITATION.  59 

among  them.  He  recovered  from  his  pulmonary  affection,  and  after 
bis  twentieth  year  gave  himself  to  masturbation,  as  he  said,/cmte  de 
mieux,  from  enforced  abstinence.  Since  that  time — for  eight  years — he 
liad  masturbated  several  times  a  week  ;  habit  continued.  According  to 
his  statement,  severe  mental  strain  attending  disappointed  affections, 
together  with  the  psycho-sexual  anomaly,  had  essentially  contributed  to 
the  development  of  the  present  state  of  nervous  exhaustion.  The 
patient  had  become  conscious  of  his  abnormal  condition  about  a  year 
before. 

Mental  depression  with  melancholic  paroxj'sms  of  weeping,  bodily 
weakness,  no  desire  to  work ;  feeling  of  lack  of  energy  especially 
noticeable ;  inability  to  complete  any  work-;  want  of  pleasure  in  life ; 
thoughts  of  suicide;  avoidance  of  people;  moodiness;  inclination  to 
hypochondria;  spinal  irritation  and  headache  following  masturbatic 
excesses.  There  was  an  unconquerable  fear  of  hetero-sexual  inter- 
course; last  coitus  performed  nine  jTears  before  without  functional  dis- 
turbance, but  with  embarrassment. 

Patient  of  delicate  constitution,  well  nourished,  of  medium  size. 
Thorax  well  developed.  Right  supra-clavicular  groove  somewhat 
sunken.  Percussion  and  auscultation  afford  no  indication  of  existent 
lung  disease.  Heart-sounds  pure ;  cardiac  dullness  normal.  Genitals 
of  medium  size;  phimosis.  The  prepuce  cannot  be  completely  retracted 
without  pain,  and  this  is  an  obstacle  to  the  performance  of  the  sexual 
function. 

Appetite,  digestion,  and  sleep  good  ;  but  rising  early  in  the  morn- 
ing requires  much  resolution.  Wakes  frequently  with  erections,  which 
lead  to  onanism.  Masturbation  twice  during  the  last  week. 

The  patient  has  great  faith  in  hypnotic  treatment,  and  wishes  to 
have  his  desire  for  work  and  his  sexual  function  restored  by  suggestive 
treatment. 

From  November  3,  1890,  he  is  treated  daily.  He  passes  into  the 
second  stage,  hypotaxis  and  suggestive  catalepsy.  Gradual  deepening 
of  hypnosis.  The  patient  remains  in  the  hypnotic  state  about  half  an 
hour,  and  passes  gradually  into  natural  sleep.  Suggestive  removal  of 
the  symptoms  and  the  inclination  to  onanism.  Repetition  of  the  influ- 
ence upon  the  feeling  and  the  desire  to  work. 

November  14th,  operation  for  phimosis;  wound  healed  at  the  end 
of  the  month. 

In  spite  of  the  removal  of  the  obstacle,  there  is  still  a  certain  reluct- 
ance to  perform  coitus.  Still,  gradually,  through  suggestive  treatment, 
it  became  possible  to  induce  the  patient  to  make  several  successful 
attempts  (during  the  first  part  of  December).  Besides,  the  patient, 
from  the  first  day  of  treatment,  began  to  emploj7  himself  in  mental  work 
with  exact  regulation  of  hours.  Gradually  the  sense  of  pleasure  in 


60  SEXUAL   HYPER^ESTHESIA. 

work  came  as  a  result  of  the  suggestions.  The  onanistic  tendencies 
were  at  first  successfully  fought  against,  and  then  they  became  less  fre- 
quent. The  gloomy  thoughts  disappeared. 

December  18th  the  patient  departed,  and,  as  the  most  important 
result  of  thirty-eight  hypnotic  sittings,  there  was  an  essential  inward 
change  in  the  patient.  He  masturbated  no  more,  and  began  to  take 
pleasure  in  hetero-sexual  intercourse.  He  took  up  a  regulated  occupation 
without  injurious  influence  on  his  nervous  system.  The  depression  dis- 
appeared, and  there  were  no  more  physical  complaints.  On  December 
15th  rheumatism  of  the  right  shoulder  was  overcome  in  two  hypnotic 
sittings.  N.  also  believed  that  he  had  gained  in  resistive  power,  for  he 
was  able  to  endure  quietly  a  very  painful  misfortune;  in  his  opinion, 
the  same  misfortune  previously  would  have  been  the  source  of  violent 
emotional  excitement. 

The  patient  went  home  delighted  with  his  unmistakable  improve- 
ment. After  his  return,  on  January  27th,  at  his  desire,  the  treatment 
was  resumed  to  change  his  improvement  into  an  actual  cure.  Though 
the  sexual  act  is  successful,  still  the  patient  has  no  desire  for  it;  and 
the  satisfaction  it  gives,  notwithstanding  complete  erection  and  ejacula- 
tion at  the  proper  time,  is  not  like  that  afforded  by  onanistic  manipula- 
tions,— an  observation  which  has  been  made  by  experienced  physicians 
in  women.1 

Up  to  March  9th  the  patient  was  subjected  to  thirty-two  more  hyp- 
notic sittings,  with  the  most  favorable  result  on  his  general  condition. 
During  this  last  period  he  performed  coitus  twice  weekly,  as  a  rule.  He 
was  no  longer  troubled  with  onanistic  inclinations.  Finally,  satisfaction 
in  the  sexual  act  and  libido  sexualis  came  up  to  the  patient's  desire.  In 
spite  of  my  advice  to  be  careful,  he  gave  himself  up  to  the  pleasures  of 
the  carnival,  and  during  the  month  of  February  had  headache  removed 
by  suggestion  three  times.  The  headache  was  referable  to  carousing  all 
night. 

March  9th  I  made  the  following  entry  in  my  journal:  "Ideas 
opposed  to  coitus  have  entirely  disappeared.  Libido  and  satisfaction 
perfect.  Embarrassment,  shyness,  and  melancholic  tendencies  no  longer 
present.  Desire  for  work  and  pleasure  in  life  have  returned.  Onanism 
overcome;  spinal  irritation  removed.  Migraine  occurs  only  after 
especial  excesses.  The  nervous  system  is  strengthened,  has  resistive 
power,  and  the  patient  is  now  fully  able  to  follow  his  occupation  and 
conclude  a  marriage  which  he  desires." 

He  is  to  be  regarded  as  completely  cured  of  his  onanism ;  on  the 
other  hand,  with  reference  to  his  neurasthenia,  considering  his  hereditary 
neuropathic  disposition,  I  can  regard  him  only  as  relatively  cured. 

The  patient  returned  home  March  9th. 

1  Comp.  Dr.  Lahmann,  "  Ueber  Onanismus  beim  Welbe  als  einer  besonderen  Form 
von  verkehrter  Richtung  des  Geschlechtstriebes,"  Therapeut.  Monatehefte,  April,  1890. 


ONANISM   BY   MEANS   OF   TACTILE   IRRITATION.  61 

Although,  in  the  foregoing  case,  hypnosis  was  repeated 
seventy  times,  there  were  never  any  injurious  effects  observed: 
no  loss  of  resistance  to  external  influence,  no  spontaneous  hyp- 
nosis, no  breaking  up  of  the  personality  (Benedikt) ;  on  the 
contrary,  the  patient,  who  had  been  shy,  languid,  devoid  of 
energy,  and  without  pleasure  in  work,  became  a  happy,  indus- 
trious man,  energetic,  and  with  normal  sexual  functions,  which 
gave  him  physical  and  mental  equilibrium  and  made  him 
capable  of  resuming  his  place  in  life. 

In  this  case  suggestive  therapy  did  all  that  was  possible. 
Whether  the  patient's  congenital  condition, — the  neuropathic 
disposition, — which  in  itself  is  unalterable,  and  the  tendency  to 
pulmonary  disease  will  again  lead  to  a  renewal  of  symptoms 
remains  to  be  seen.  Thus  far,  we  can  only  say  that,  according 
to  the  patient's  reports,  up  to  the  present  time  he  follows  his 
occupation  industriously. 

Case  15.  Personal  Observation.  Successful  Suggestive  Removal  of 
Imperative  Sensations  Due  to  Onanism. — G.,  male,  aged  26.  Paternal 
grandfather  drinker ;  maternal  grandparents  died  of  tuberculosis.  Mother 
neurasthenic,  timid,  easily  excited.  Father,  brother,  and  sister  healthy. 
Father's  relatives  subject  to  heart  disease.  In  childhood  patient  had 
measles  and  pleuritis,  and  later  several  attacks  of  fever  (malaria?).  G. 
is  robust  and  strong,  and  weighs  200  pounds.  Greatly  developed  pan- 
niculus  adiposus.  Heart  and  lungs  without  demonstrable  disease.  G. 
presents  an  hereditary  neuropathic  constitution.  According  to  his  auto- 
biography, as  a  child  he  was  easily  excited  and  remarkably  irritable,  and 
was  eccentric.  From  his  twelfth  to  his  fourteenth  year  he  masturbated 
several  times  daily,  without  noticeable  unfavorable  effect  on  his  physical 
health.  On  the  other  hand,  the  onanistic  excesses  seem  to  have  been 
the  exciting  cause  of  development  of  psycho-neurasthenic  symptoms; 
for  since  that  time  the  patient's  memory  had  grown  remarkably  weak, 
and  he  had  lost  energy.  As  a  child  shy  and  retiring,  he  now  kept  more 
and  more  to  himself,  and  his  timidity  often  became  the  object  of  joke  by 
his  companions.  A  book  on  "self-protection"  explained  to  him  the 
injurious  effects  of  onanism,  and  he  abandoned  the  vice.  G.  gives  the 
impression  of  an  apathetic,  weak-willed  man,  devoid  of  self-confidence. 
Without  advice,  he  gave  himself  to  the  study  of  medicine.  In  spite  of 
his  fourteen  semesters,  he  is  still  a  diligent  student.  Two  years  and  a 
half  ago,  after  nine  semesters,  he  passed  the  physicum.  He  is  constantly 
troubled  with  the  knowledge  of  having  been  left  behind  by  his  com- 


62  SEXUAL   HYPER^ESTHESIA. 

panions,  and  avoids,  as  far  as  possible,  his  former  comrades,  who  have 
become  practicing  physicians.  He  has  also  abandoned  his  best  friends. 
He  likes  best  to  take  long,  solitary  walks,  and,  without  thinking  more 
deeply  of  his  fate,  lives,  as  he  expresses  himself,  "  Tag  fur  Tag  ins  Blaue 
hinein." 

He  has  no  desire  for  sexual  intercourse,  but  from  time  to  time  he 
performs  coitus  normally,  in  order  to  prevent  pollutions,  which  otherwise 
are  frequent  (three  weekly).  He  is  potent  or  impotent  according  to  the 
mental  condition  at  the  moment.  Physically,  the  patient  complains  that 
on  the  slightest  excitement  he  has  cardiac  palpitation  and  outbreaks  of 
perspiration.  At  school  he  was  timid  and  blushed  whenever  his  name 
was  called.  These  imperative  states  of  anxiety  are  at  present  prominent 
in  his  trouble.  When  he  is  called  upon  by  one  of  his  clinical  teachers 
to  examine  a  case,  this  feeling  of  anxiety  overcomes  him,  so  that  he  feels 
paralyzed  and  wholly  unable  to  answer  or  even  to  leave  the  auditorium. 
Owing  to  this,  the  patient  has  not  been  able  to  obtain  the  eight  certifi- 
cates of  practice  necessary  to  allow  him  to  take  the  State  examination. 
He  has  put  off  this  duty  from  semester  to  semester.  At  the  present 
time  (June)  he  has  the  alternative  of  losing  a  year  or  of  overcoming  the 
impediment  during  the  last  month  (July)  of  the  semester. 

This  painful  position,  which  makes  G.  incapable  of  doing  anything 
and  brings  his  future  in  question,  induced  him  to  consult  me  on  June 
22d. 

June  25th,  fir^t  hypnotic  attempt  (method  of  Bernheim-Lie'beault). 
G.  passes  into  the  second  stage, — i.e.,  in  spite  of  retained  consciousness, 
he  is  unable  to  resist  the  suggestions.  Suggestions  :  (a)  After  waking, 
you  will  ask  me  for  a  cigarette.  (6)  You  must  obey  unconditionally  the 
next  call  to  u  practice,"  like  an  automaton,  and  will  be  unable  to  keep 
your  seat. 

After  waking,  the  patient  declared  that  he  had  not  slept,  but  that, 
only  to  please  me,  he  had  kept  the  position  suggested.  He  thought  this 
first  attempt  had  been  entirely  unsuccessful,  in  accordance  with  his  pre- 
conceived notion  of  hypnosis  and  the  actual.  Apparently,  he  took  me 
for  a  credulous  person,  and  left  without  performing  the  post-hypnotic 
suggestion.  As  the  later  statements  of  G.  revealed,  after  leaving  me,  he 
went  to  a  friend  about  4  o'clock.  Strange  to  say,  here  the  thought  of  a 
cigarette  came  and  did  not  leave  him.  Unwilling,  and  annoyed,  he  left 
his  friend's  house  at  5  o'clock  to  find  himself,  a  little  later,  in  the  park  in 
front  of  my  dwelling.  For  an  hour  he  struggled,  walking  in  the  park, 
against  the  impulse  to  regain  his  equilibrium  by  visiting  me.  At  6 
o'clock  he  called,  but  did  not  find  me  in.  The  next  morning,  at  10 
o'clock,  the  patient  entered  with  the  words,  "  A  cigarette,  please ;  and  I 
promise  to  really  '  practice  '  from  this  time  forward."  The  self-deception 
of  many  patients  concerning  the  events  of  hypnosis,  to  which,  also, 


ONANISM   BY   MEANS   OF   TACTILE  IRRITATION.  63 

Bernheim  and  Forel  have  repeatedly  called  attention,  could  not  be  more 
clearly  illustrated  than  by  this  experience  with  a  person  who,  owing  to 
his  medical  education,  was  the  more  entitled  to  express  an  opinion. 

As  early  as  June  26th  the  patient  was  able  to  master  his  imperative 
feelings, — i.e.,  to  practice. 

G.  was  thereafter  hypnotized  five  times:  on  June  26th,  27th,  and 
30th,  and  July  2d  and  llth. 

Relapse  between  the  4th  and  llth  of  July.  Inability  to  respond  to 
his  name  in  the  gynaecological  clinic.  After  energetic  suggestion  on 
July  llth,  the  patient  went  voluntarily  to  the  assistants  at  the  clinic, 
and  a  few  days  after  this  hypnosis  he  obtained  the  needed  certificate. 

August  1st  G.  informed  me,  with  delight,  that  he  had  all  eight  cer- 
tificates necessary  to  allow  the  State  examination.  He  was  of  the 
opinion  that  he  never  could  have  obtained  them  with  his  own  efforts 
without  the  suggestive  stimulation. 

The  psychical  after-effect  of  this  success  upon  the  patient's  self- 
consciousness  was  unexpectedly  favorable.  His  mood  was  lightened 
and  hope  raised.  Although,  from  the  stand-point  of  the  physician,  the 
patient  was  by  no  means  to  be  regarded  as  cured,  still,  I  had  to  follow 
the  wishes  of  the  patient,  who,  relying  upon  his  own  powers,  thought 
he  could  dispense  with  further  suggestive  treatment,  and  desired  to 
attempt  his  own  cure. 

I  regard  this  case,  so  instructive  for  suggestive  therapy,  as  worthy 
of  report,  because,  between  the  onanistic  excesses  and  the  development 
of  the  psycho-neurasthenic  symptoms  which  became  especially  promi- 
nent on  June  22d,and,  though  weakened,  are  still  present  to  a  certain 
extent,  there  seemed  to  be  an  etiological  relation. 

Case  16.  Personal  Observation.  Masturbatic  Inclinations  and  Neu- 
rasthenic Symptoms.  Successful  Treatment  by  Suggestion. — A.,  male, 
aged  19  years.  Mother  nervous.  Father  and  other  members  of  family 
healthy.  No  severe  illness  aside  from  diseases  of  childhood.  He  mas- 
turbated from  his  fourteenth  j'ear  with  the  idea  of  coitus,  at  first  daily, 
later  once  or  twice  a  week.  « 

A.  finds  that  his  mental  strength  suffers.  He  grows  weak-willed 
and  has  no  more  power  of  endurance.  Easily  tired  mentally.  Inability 
to  carry  on  his  studies  regularly.  Great  confusion.  He  has  seldom 
performed  coitus  and  has  a  remarkable  shyness  about  intercourse.  He 
is  treated  in  twelve  h}Tpnotic  sittings ;  passes  into  hypotaxis  at  the  first 
attempt.  He  relapsed  but  once  during  the  course  of  treatment.  The 
masturbatic  inclinations  disappeared,  and  he  performed  coitus  once  a 
week.  His  ability  to  work  returned.  Subjective  feeling  of  well-being 
returned,  and  at  the  present  time  complaints  of  neurasthenic  symptoms 
have  ceased.  He  is  still  under  observation,  but  he  may  already  be 
regarded  as  essentially  improved. 


64  SEXUAL   HYPER.ESTHESIA. 

ONANISM  THROUGH  PSYCHICAL  STIMULI. 
(Cases  17  and  18.) 

Case  17.  Observation  by  Dr.  Wetter  strand.  Psychical  Onanism  Es- 
sentially Improved  by  Suggestive  Treatment. — X.  X.,  medical  student, 
aged  26  years.  While  during  a  year  he  was  engaged  to  be  married  he 
noticed  that  sometimes  lascivious  thoughts  came  to  him.  He  fought 
against  them  strenuously,  but  without  success.  His  fancy  was  filled 
with  frivolous  images,  and,  at  the  sight  of  his  fiancee  and  other  ladies 
of  attractive  appearance,  he  experienced  irritation  and  tickling  on  his 
penis,  which  were  accompanied  by  erection,  often  ending  with  ejacula- 
tion. He  suffered  with  this  inability  to  control  his  imagination,  and 
therefore  consulted  me  on  October  22,  1889.  He  was  hypnotized  five 
times,  and,  although  the  time  was  so  short,  he  was  still  considerably 
improved. 

On  December  14th  the  patient  wrote :  "  I  feel  that  my  trouble  has 
been  considerably  ameliorated,  and  therefore  I  would  once  more  express 
to  you  my  warmest  thanks." 

Case  18.  Personal  Observation.  Psychical  Onanism  (due  to  Mastur- 
bation Practiced  during  Eight  Years),  with  Hysterical  Symptoms  and 
Beginning  Apathy,  Cured  by  Suggestion. — A.,  female,  aged  20.  Mother 
nervous.  Father  died  three  years  ago  with  apoplexy.  Grandfather 
healthy.  A.  has  had  no  especial  diseases.  She  has  menstruated  since 
her  fourteenth  year,  and  has  masturbated  about  as  long.  She  seems  to 
have  had  pruritus  vulvse,  which  the  sexual  irritation  followed.  Uncer- 
tain on  her  legs  for  years.  The  emotional  shock  caused  by  the  death  of 
her  father,  three  years  ago,  was  very  severe  in  its  effects  on  her.  She 
became  nervous,  often  aphonic;  complained  much  of  headache  and  pain 
in  the  abdomen  ;  restless  sleep,  loss  of  appetite,  dizziness.  A.  became 
more  quiet  and  apathetic,  and  took  less  interest  in  everything.  She  was 
treated  by  the  family  physician  with  medicines  and  electricity  without 
result.  Repeated  attempts  to  hypnotize  her  were  unsuccessful.  She 
then  came  to  X.,  and  was  treated  by  Dr.  P.,  to  whom  I  am  indebted  for 
these  facts.  To  the  complaints  mentioned  were  added  vomiting,  diar- 
rhoea, anaemia.  At  the  same  time  there  .was  great  desire  for  medicines 
(phenacetin,  antipyrin,  and  bromides).  It  was  difficult  to  keep  her  from 
using  these  medicines.  The  hysterical  attacks  recurred  again  and  again  ; 
in  September,  1890,  quite  severe  hysterical  attacks,  with  weeping,  crying 
out,  confusion,  but  with  retained  consciousness.  At  that  time  Dr.  P. 
had  but  a  suspicion  of  masturbation.  Spots  of  blood  on  the  linen  that 
had  been  partially  rubbed  out  and  a  careful  questioning  induced  the 
patient  to  confess. 

During  this  period  she  masturbated  very  frequently ;  at  least,  several 
times  a  day  she  rubbed  the  vulva  and  clitoris,  and  at  night  she  always 
had  a  finger  in  the  vulva  or  vagina.  Irritation  and  itching  became 


ONANISM   THROUGH   PSYCHICAL   STIMULI.  65 

especially  intense  immediately  before  and  after  menstruation.  The  whole 
vulva  was  greatly  swollen  and  there  was  fluor  albus.  Applications 
of  carbolic  acid,  cocaine,  and  glycerin  with  chloroform,  were  without 
effect.  Faradization  of  the  vulva  was  temporarily  beneficial,  and  it  was 
used  twice  daily  until  she  was  sent  to  Munich.  Owing  to  her  great  lack 
of  voluntary  control,  she  was  placed  under  the  constant  care  of  a  nurse, 
and  day  and  night  her  arms  and  legs  were  secured.  For  sleep  she  was 
given  sulphonal  gr.  xxx  and  paraldehyde  Siss,  alternately.  The  tendency 
to  masturbate  continued  strong.  Whenever  it  was  possible  she  made 
shoving,  rubbing  movements  with  the  legs,  the  pelvis'  (on  the  edge  of  the 
chair),  masturbated  through  her  clothing  (hand  in  pocket) -while  out 
walking,  and  used  every  opportunity  in  the  bath,  etc.  One  night  she 
succeeded  in  releasing  herself,  and  in  the  morning  she  was  again  found 
with  her  finger  in  her  vagina.  During  the  last  six  or  seven  weeks  of 
her  stay  in  X.,  she  did  not  directly  touch  the  vulva  with  the  finger  or 
hand,  and  she  also  tried  to  give  up  the  movement  on  chairs.  She  walked 
out  often  and  slept  without  medicine;  but  she  was  often  restrained 
during  the  day,  and  always  at  night. 

In  May,  1891,  Dr.  P.  made  three  attempts  to  hypnotize  the  patient; 
at  the  third  she  went  to  sleep,  but  suggestion  was  unsuccessful.  Further 
attempts  were  not  made.  Weight,  when  received,  90  pounds;  January, 
1891,  100  pounds;  September,  1891,  92  pounds.  Even  though  there  had 
been  unmistakable  improvement,  Dr.  P.  thought  that  hypnotic  treatment 
might  lead  to  complete  recovery,  and  sent  the  patient  to  me  in  Munich 
in  the  middle  of  September. 

After  personal  examination  on  September  17th  and  18th,  I  was 
able  to  extend  Dr.  P.'s  observations  and  statements,  as  follows :  Heart 
and  lungs  apparently  healthy.  The  patient  appears  as  about  16  years 
old.  Sensation  to  painful  impressions  increased  on  the  flexor  surface 
of  extremities ;  reduced  on  the  extensor  surface,  and  in  part  absent. 
The  tactile  sense  at  some  points,  especially  on  the  extensor  surface  of 
the  upper  arm,  is  diminished.  No  disturbance  of  temperature  sense, 
localization,  or  muscular  sense.  Uterus  and  ovaries  sensitive  to  press- 
ure ;  intense  hyperaesthesia  of  the  vulva.  Bilateral  peripheral  narrow- 
ing of  the  visual  field.  Color  sense  normal;  likewise  acuity  of  vision 
and  hearing,  but  easily  fatigued.  Smell  and  taste  normal.  There  is 
constant  headache,  pain  in  the  abdomen,  and  unbearable  itching  of  the 
genitals.  Weight,  93  pounds.  Haemoglobin,  75  per  cent,  (estimated 
with  Gowers's  haemoglobinometer). 

Patient  seems  depressed  mentally.  Complete  weakness  of  memory  ; 
so  that  the  patient,  for  example,  cannot  recapitulate  the  words  and 
meaning  of  a  short  written  extract.  Want  of  energy  and  dull  apathy 
for  all  external  impressions.  She  performs  automatically  what  she  is 
told  to  do.  She  has  no  interest  whatever  in  employment  or  pleasures 

5 


66  SEXUAL   HYPER^ESTHESIA. 

(theatres,  concerts).  Lack  of  all  spontaneity.  She  asks  no  questions 
and  opposes  all  efforts  to  rouse  her  from  her  indolence.  Occasional 
transformation  of  this  state  to  exaltation,  loud  hysterical  laughing,  and 
cramp-like  convulsions. 

Observation  for  several  days  and  careful  examination  of  the  patient 
show  that  the  present  form  of  gratification  is  psychical  onanism.  The 
idea  of  a  male  person, — one  of  her  relatives, — as  well  as  his  caresses, 
induce  sexual  orgasm,  without  mechanical  help  of  movement  of  the 
limbs,  which  is  manifested  in  slight  convulsive  jerking.  The  patient 
knows  nothing  of  sexual  intercourse,  conception,  etc.,  and  therefore  her 
imagination  is  never  filled  with  lascivious  images  and  scenes ;  but,  in 
remarkable  contrast  with  her  libido  sexualis,  it  has  remained  pure,  like 
that  of  a  child.  Pleasant  or  intense  lustful  sense-impressions  of  various 
kinds  are  capable  of  inducing  orgasm;  thus,  for  example,  scenes  at  the 
theatre,  musical  impressions,  or  the  sight  of  beautiful  pictures,  which 
need  contain  no  figures  (human),  like  beautiful  landscapes,  suffice.  Like- 
wise, simple  bodily  contact  (hand-pressure)  with  attractive  persons 
induces  lustful  trembling.  The  patient  masturbated  near  me  three 
times  in  the  horse-cars,  and  that  without  any  noticeable  movement.  At 
the  same  time,  like  many  hysterical  persons,  she  was  not  without  great 
cunning,  and  only  after  close  questioning  did  she  confess  the  truth  with 
reference  to  the  number  of  her  sexual  attacks. 

September  18,  1891,  first  hypnotic  experiment  (Lie*beault-Bernheim 
method).  Hypotaxis,  suggestive  cataleptic  phenomena,  with  inability 
to  resist  the  suggestions.  No  post-hypnotic  amnesia.  Owing  to  tiie 
marked  apathy,  the  patient  comprehends  the  suggestions  with  diffi- 
culty ;  the  ideational  stimuli  must  be  made  very  energetically,  and  often 
repeated,  in  order  to  make  them  effectual.  From  this  time  she  received 
the  following  suggestions  daily  :  (a)  abhorrence  of  every  kind  of  onan- 
ism ;  (6)  purity  of  thoughts;  (c)  cessation  of  headache,  abdominal  pain, 
and  itching;  interest  in  external  affairs. 

After  going  into  the  hypnotic  state,  the  patient  daily  continues  in 
hypnosis  from  a  half-hour  to  an  hour  and  a  half.  Besides,  with  the  con- 
sent of  her  mother,  the  sexual  relations  and  the  dangers  of  self-abuse 
are  rationally  explained  to  her. 

Patient  states  that  she  does  not  dream  ;  at  least,  she  has  no  memory 
of  dreaming;  but  her  restless  sleep  and  violent  headache  on  awakening 
daily,  as  well  as  the  depression  associated  with  it,  give  rise  to  the  pre- 
sumption that,  even  with  restrained  arms  and  legs,  the  psychical  onanism 
is  continued  in  dreams. 

According  to  my  notes,  with  daily  continuance  of  the  hypnotic 
treatment,  the  decrease  in  the  frequency  of  the  onanistic  attacks  was  as 
follows  : — 

Auto-sexual  satisfaction  by  means  of  idea :  September  21st  (for  the 


ONANISM   THROUGH   PSYCHICAL   STIMULI.  67 

last  twenty-four  hours),  6  attacks  (1  by  means  of  friction);  September 
22d,  3  attacks;  September  23d,  2  attacks;  September  24th,  1  attack; 
September  25th,  2  attacks ;  September  27th,  4  attacks  ;  September  29th 
and  30th,  none;  October  1st,  2  attacks  (from  looking  at  paintings); 
October  2d,  none  ;  October  3d,  none,  and  none  on  the  days  following. 

During  October  there  was  unmistakable  improvement.  She  stated 
that  she  avoided  all  ideas  that  could  have  induced  attacks,  and  relapse 
was  infrequent.  This  improvement  was  recognizable  objectively  in  the 
patient's  general  condition.  She  became  more  lively  ;  asked  questions  of 
those  about  her  and  of  the  physician  ;  employed  herself  in  reading,  read- 
ing aloud,  and  letter-writing,  and  her  mood  and  mind  became  brighter 
and  more  active. 

Relatively,  the  most  favorable  time  in  the  patient's  condition  was 
always  immediately  after  hypnosis  ;  in  contrast  with  her  restless  sleep  at 
night,  she  slept  in  perfect  quiet.  During  these  post-hypnotic  periods, 
which  at  first  lasted  an  hour,  then  four  hours,  and  finally  the  remainder 
of  the  day,  the  stimulus  to  masturbate  and  the  itching  were  absent,  pain 
ceased,  and  her  mood  was  pleasant.  Thus,  suggestive  treatment  showed 
itself  to  be  the  most  effectual  of  all  curative  means,  and  always  gave  the 
patient'great  relief.  To  overcome  the  hypersesthesia  of  the  genitals  and 
the  pruritus  vulvae,  daily  sitz-baths  gradually  cooled,  frequent  use  of 
vaginal  tampons,  application  of  cocaine  solution,  ointments  with  calo- 
mel, frequent  cold  bathing,  etc.  Besides,  on  retiring,  bromides  and  sul- 
phonal  were  given  to  induce  quiet  sleep,  and  to  have  an  anaphrodisiac 
effect.  The  application  of  the  galvanic  current  was  also  finally  used  to 
combat  the  headache  and.the  feeling  of  pressure  in  the  occipital  region 
(especially  mornings  after  waking).  Further,  in  order  to  stimulate  her 
mind  and  divert  her  attention  from  her  favorite  dreams,  the  patient  was 
taught  in  several  studies.  Gymnastic  exercises,  within  the  customary 
limits  for  young  girls,  completed  the  general  treatment. 

The  patient  is  still  treated  in  this  manner,  and  her  improvement  is 
to  be  attributed  in  greater  part  to  the  forty-two  hypnotic  sittings.  She 
grows  brighter  mentally ;  sleep  grows  quieter ;  pain  becomes  less  fre- 
quent and  intense  ;  the  post-hypnotic  remissions  grow  longer ;  the  hyper- 
aesthesiaof  the  vulva  is  essentially  diminished.  The  stimulus  to  mastur- 
bate and  the  itching  occur  less  frequently,  and  the}'  are  weaker.  Of  late 
there  are  no  more  onanistic  relapses,  though  the  patient  is  still  restrained 
at  night  as  a  precaution.  Gradually  the  patient  has  developed  an  intense 
repugnance  for  onanism,  so  that  finally  every  question  on  the  subject  is 
answered  with  irritation  and  repugnance  for  the  vice.  The  progress  is 
slow,  but  constant,  and  she  may  alread}'  be  regarded  as  essentially  im- 
proved. Present  weight,  98  pounds ;  haemoglobin,  80  per  cent. 

From  September,  1891,  to  April,  1892,  the  patient  was  treated  with 
about  one  hundred  and  fifty-two  hypnotic  sittings,  and  during  the  last 


68  SEXUAL   HYPER^ESTHESIA. 

four  months  she  regularly  passed  into  deep  somnambulism.  Since  this 
time  she  has  masturbated  no  more,  and  may  be  regarded  as  essentially 
cured.  For  a  month  there  has  been  endometritis,  which  has  yielded  to 
local  treatment.  Headache  and  abdominal  pain  have  disappeared  en- 
tirely, as  well  as  the  troublesome  itching.  From  a  languid,  apathetic 
patient,  she  has  become  a  bright  young  girl  of  gay  mood,  with  a  fresh, 
blooming  appearance,  and  full  of  interest  in  all  that  takes  place  around 
her.  She  will  be  sent  home  in  a  few  days  as  cured. 

SATYRIASIS  AND  NYMPHOMANIA. 
(Cases  19  and  20.) 

Case  19.  Professor  For  el,  Zurich.  Satyriasis,  with  Weakness  of 
Will  and  Inability  to  Work,  Lastingly  Cured  by  Hypnotic  Suggestion. — 
Mr.  X.,  student,  aged  25,  came  to  me  in  July,  1889,  for  consultation. 
Since  1885  he  had  committed  sexual  excesses,  either  with  women  or  in 
onanism.  The  impulse  became  irresistible  two  or  three  days  after  the 
last  indulgence  ;  he  was  forced  to  masturbate.  Mentally  aifected  by  it 
(probably  by  the  mental  impression,  through  auto-suggestion,  rather  than 
by  the  number  of  emissions)  ;  since  the  summer  of  1888  he  had  become 
so  languid  and  weak  of  will  that  he  was  absolutely  incapable  of  work. 
He  remained  in  his  room,  listless  and  abulic,  and  did  nothing,  totally 
neglecting  his  studies,  and  he  could  not  continue  his  work  for  the 
doctorate. 

In  this  condition,  which  had  existed  for  a  year,  he  came  to  me,  told 
all,  and  asked  for  help.  In  July,  1889,  I  hypnotized  him,  and  brought 
about  hypotaxis  (without  amnesia).  Ability  'to  work  returned  imme- 
diately ;  the  spell  was  broken.  Mr.  X.  was  hypnotized  six  or  eight  times 
in  all.  There  was  likewise  great  improvement  as  regarded  onanism  ;  at 
first  it  gradually  diminished.  Now  and  then  it  was  still  practiced,  and 
for  the  last  time  in  February,  1890.  However,  the  sexual  instinct  lost, 
as  a  result  of  suggestion,  its  violent,  impulsive  character,  and  soon  be- 
came perfectly  normal, — i.e.,  aside  from  infrequent  coitus,  at  the  most, 
there  was  but  one  pollution  a  week.  Since  the  first  hypnotic  sittings 
(July,  1889)  his  ability  to  work  has  continued  undisturbed  and  unlimited 
up  to  the  present  time  (July,  1890).  He  was  not  hypnotized  thereafter. 
Mr.  X.  was  always  nervous,  but  otherwise  of  genial  temperament  and 
normal. 

Case  20.  Personal  Observation.  Nymphomania  with  Hystero-Mastur- 
batic  Attacks.  Cured  by  Suggestion. — M.,  aged  22,  teacher.  Father 
died  of  spinal  disease.  Mother  healthy.  Two  cousins  insane.  Brothers 
and  sisters  healthy-  The  eldest  sister  is  said  to  be  remarkably  apathetic. 
M.  was  healthy  in  her  early  youth.  When  she  was  about  5  years  old 
and  living  in  a  large  city,  for  a  long  time  an  officer  was  accustomed  daily 
to  take  her  up  from  play  with  her  companions  immediately  after  closing 


SATYRIASIS   AND   NYMPHOMANIA.  69 

his  office.  He  took  the  innocent  child  to  his  room,  caressed  her,  touched 
her  genitals,  and,  after  having  covered  her  eyes  and  mouth,  he  committed 
immoral  acts  with  her, — masturbated  her,  undressed  her,  and  became 
intensely  excited  sexually,  probably  with  orgasm.  The  pleasant  feelings 
which  he  caused  the  child  by  his  manipulations,  on  the  one  hand,  and 
threats  to  kill  her  if  she  were  to  tell  on  him,  on  the  other,  caused  M.  to 
keep  silent  concerning  the  matter.  In  this  way,  during  the  two  years 
of  continued  intercourse,  the  childish  imagination  was  thoroughly  pois- 
oned. After  the  relation  ceased,  the  child  began  to  practice  auto-mas- 
turbation excessively.  At  the  age  of  11  the  menses  began.  At  the  age 
of  17  she  went  to  France  as  a  teacher,  and  at  18  she  was  deflowered,  and, 
up  to  the  present  time,  states  that  she  has  had  coitus  about  ten  times. 
A  relative  accompanied  her  to  my  office,  and  I  noted  the  nervous  ex- 
citement of  the  former.  A  short  examination  showed  that  her  companion 
was  more  seriously  affected  than  M. 

During  the  last  ten  3' ears  the  onanistic  manipulations  have  been 
practiced  from  eight  to  twelve  times  dail3',  and  have  seriously  affected 
M.'s  predisposed  nervous  S3rstem.  She  states  that  she  has  never  touched 
her  genitals  with  her  hands,  but  she  induces  the  orgasm  by  movements 
of  the  thighs  ;  its  occurrence  is  often  accompanied  by  l^sterical  convul- 
sions and  loss  of  consciousness.  The  patient  feels  much  fatigued  after 
these  onanistic  attacks.  The  ideas  accompanying  such  attacks  often 
consist  of  the  thought  of  having  intercourse  with  some  man.  The  in- 
tensity of  such  thoughts  often  reaches  that  of  hallucination.  The  severest 
attacks  occur  in  the  morning,  while  the  patient  is  tying  on  her  abdomen 
in  bed.  She  states  that  at  such  times  the  impulse  is  irresistible.  She 
is  absolutely  unable  voluntarily  to  control  the  impulse,  and  thus  she  has 
become  the  slave  of  the  psycho-sexual  reflex  mechanism,  whichjs  thrown 
into  action  by  all  kinds  of  sensoiy  impressions  and  ideas.  For  some 
years  orgasm  has  taken  phice  without  tactile  stimulation  of  the  genitals 
at  the  occurrence  of  certain  perceptions,  accompanied  by  intense  pleas- 
urable feeling  (psychical  onanism) ;  thus,  for  example,  when  the  patient 
sits  dreaming  on  the  sea-shore  watching  the  pla}'  of  the  waves;  while 
lost  in  contemplation  of  the  river  Isar;  while  looking  at  certain  paint- 
ings containing  nude  figures,  or  even  at  landscapes  devoid  of  figures;  at 
the  sight  of  attractive  male  forms;  or  even  at  the  mere  contact  with  a 
man  (pressure  of  hand).  These  ideas  in  the  form  of  memory-pictures 
are  also  sufficient,  without  mechanical  friction,  to  induce  the  sexual 
orgasm. 

In  general,  all  sensory  impressions  and  ideas  which  induce  pleas- 
urable sensations  are  capable  of  bringing  about  lustful  feelings.  The 
patient's  dreams  are  also  effectual  in  the  same  wa3r.  She  states  that  a 
short  time  ago  she  dreamed  that  she  was  in  the  arms  of  the  emperor. 
Her  whole  thought  is  directed  to  the  sexual  sphere.  Her  impulsive 


70  SEXUAL   HYPER^STHESIA. 

excitement  reaches  the  intensity  of  nymphomania,  with  an  inclination 
to  attack  men.  She  fears  her  own  passion,  and  begs  me  never  to  leave 
her  alone  with  a  man  in  the  waiting-room.  In  such  states  of  excitement 
it  is  only  with  the  greatest  difficulty  that  she  controls  herself.  Increased 
cardiac  action,  rapid  breathing,  and  suffusion  of  the  face  are  the  object- 
ive signs  of  her  exaltation.  Repeated  onanism  during  the  first  visits  to 
the  physician,  as  well  as  during  the  physical  examination. 

Her  mental  condition  has  seriously  suffered  under  the  constant  in- 
fluence of  this  sexual  hypenesthesia  that  has  existed  for  years.  Weak- 
ness of  memory,  absent-mindedness,  inability  to  follow  out  a  thought, 
hysterical  change  of  mood,  etc.,  make  it  impossible  for  her  at  present  to 
follow  any  employment.  Nevertheless,  with  due  consideration  of  her 
hysterical  state  of  mind,  she  does  not  impress  one  as  being  a  person 
degraded  or  morally  defective.  She  feels  that  she  is  ill,  and  has  an 
earnest  desire  to  get  well,  but  that  she  cannot  attain  this  by  means  of 
her  own  strength.  She  has  by  no  means  lost  her  sense  of  modesty,  and, 
in  spite  of  her  violent  sexual  impulses,  she  has  not  prostituted  herself. 
The  dramatic  dream-life  of  the  patient,  as  fully  revealed  later  during 
hypnosis,  gave  the  observer  a  view  of  the  patient's  secret  mental  life  and 
many  opportunities  for  interesting  psychological  studies.  These  experi/- 
ences  confirmed  the  judgment  made  of  her  character  in  the  waking 
state. 

M.'s  form  is  stately  ;  full  bust.  Panniculus  adiposus  well  developed. 
Mucous  membrane  ruddy.  Heart  and  lungs  normal.  On  the  posterior 
surface  of  the  right  forearm  there  is  an  area  of  anaesthesia,  pear-shaped, 
fifteen  centimetres  long  and  seven  centimetres  wide.  In  the  right  axil- 
lary line,  at  the  level  of  the  fourth  rib,  there  is  a  point  sensitive  to 
pressure  ; -right  ovary  also  sensitive  to  pressure.  Genitals  normal,  not 
especially  sensitive  ;  moderate  turgor  of  the  clitoris,  which  is  remarkably 
large.  Occasional  pruritus  vulvse.  Color-blind  for  blue  and  red.  The 
right  visual  field  concentrically  narrowed.  Olfactory  and  gustatory 
anaesthesia  on  the  right  side.  Quinine  and  salt  are  not  tasted  on  the 
right  side  of  the  tongue  ;  asafoetida,  violet  perfume,  and  smelling-salts 
are  not  smelled  on  the  right  side.  On  the  other  hand,  on  the  left  side, 
these  substances  induce  lively  reaction,  with  correct  recognition  of 
them.  No  olfactory  hallucinations.  Hearing  intact  on  both  sides. 

The  menses  increase  the  hyperaesthesia,  last  four  days,  and  cause 
pain  and  weariness  in  the  legs.  Repeated  vesicular  spasm  with  active 
retention  of  urine  (attributable  to  reflex  irritation  after  onanistic  ex- 
cesses) on  attempting  to  urinate.  As  a  rule,  the  spasm  ceases  after  five 
minutes. 

September  25th  I  attempted  to  hypnotize  her  for  the  first  time,  but 
without  success.  With  face  suffused  and  excited,  she  threw  herself 
about  in  her  chair,  and  the  attempt  ended  with  an  hystero-onanistic 


SATYRIASIS   AND   NYMPHOMANIA.  71 

attack.  I  then  had  her  come  every  clay,  and  showed  other  hypnotized 
patients,  and  suggested  to  her  in  the  waking  state  that  she  was  not  to 
become  excited  when  visiting  the  physician.  Thereafter  she  became 
much  quieter,  and  I  could  touch  her  without  causing  her  sexual  excite- 
ment. She  then  asked  to  be  hypnotized. 

September  30th,  second  hypnotic  attempt  (Liebeault-Bernheim 
method).  In  less  than  a  minute  M.  goes  to  sleep  and  passes  into  deep 
somnambulism,  with  post-hypnotic  amnesia.  She  carries  out  all  sug- 
gestions, hallucinations,  acts,  and  commands  in  the  domain  of  the  body 
with  perfect  precision.  She  is  one  of  the  best  somnambulists  I  have 
ever  seen  (sonambule  agitee).  As  a  rule,  if  no  centra-suggestion  is 
given,  she  acts  out  her  dreams,  speaks  of  the  events  of  her  daily  life, 
and  takes  up,  from  time  to  time,  an  imaginary  glass  from  the  table  to 
strengthen  herself,  and  has  hallucinations  of  all  possible  situations. 
After  I  have  suggested  to  her  abhorrence  for  onanism,  she  always  says 
to  herself  the  following  sentences :  "  Ugh  !  that  is  bad ;  you  must  not 
be  naughty  ;  the  doctor  does  not  allow  you  to  be  ;  I  abhor  it."  In  the 
following  sittings,  auto-suggestive  recapitulation  of  the  suggestive  com- 
mands of  previous  sittings.  She  twice  struggles  successfully  against 
the  impulse  to  onanism  in  hypnotic  dreams.  Once,  in  a  dream,  she 
allows  the  imaginary  glass  to  fall  to  the  floor;  she  begs  pardon,  and 
wishes  to  take  up  the  pieces.  When  it  is  suggested  to  her  that  a  lead- 
pencil  is  a  red-hot  iron  with  which  she  is  to  be  burned  on  the  arm,  the 
touch  is  followed  by  violent  painful  reaction,  manifested  by  jerking  the 
arm  away  and  crying  out.  Sometimes  the  places  touched  on  the  arm 
clearly  showed  a  red  line  (the  first  degree  of  burning)  ;  at  other  times 
there  was  nothing  apparent.  On  one  occasion  desquamation  of  the 
superficial  la}rer  of  the  skin,  with  formation  of  crusts  for  some  days; 
but  it  is  not  certain  whether  or  not  this  process  was  hastened  or  brought 
about  by  scratching  or  rubbing  at  times  when  she  was  not  under  observa- 
tion. In  one  instance  she  blew  on  the  spot  that  appeared  burned  (not  yet 
erythematous),  and  poured  the  contents  of  this  imaginary  glass  over  it,  in 
her  imagination  thus  overcoming  the  irritation, — all  this  without  the  skin 
reacting  with  redness. 

Every  one  of  the  stigmatic  experiments  tried  by  me  on  this  patient 
underwent  correction  when  I  ascertained  that  in  the  waking,  as  well 
as  in  the  sleeping,  state  every  moderately-intense  tactile  impression 
induced  circumscribed  hypersemia  of  the  skin,  whether  there  was  any 
suggestion  at  the  same  time  or  not.  With  moderate  pressure  with  a 
piece  of  wood  (lead-pencil)  one  can  draw  on  the  skin  of  the  arm,  breast, 
etc.,  any  kind  of  a  figure,  which,  in  half  a  minute,  appears  as  an  erythema 
traumaticum  in  the  form  of  the  figure  drawn.  In  this  way  the  word 
"  Otto  "  appeared  in  red  letters  on  the  left  breast;  likewise  the  number 
"  1 "  which  I  had  written  on  her  arm  over  the  sleeve.  Still,  the  possi- 


72  SEXUAL   HYPER^ISTHESIA. 

bility  that  this  may  be  induced  by  the  ideational  stimulus  is  not  thus 
denied. 

We  see  other  vasomotor  changes  brought  about  by  psychical  stim- 
ulus as  well  as  by  tactile  irritation  :  for  example,  erection.  Careful 
exclusion  of  mechanical  irritation  is  necessary  to  establish  the  occur- 
rence of  erythema  as  a  result  of  suggestion.  Though  some  of  the  sug- 
gestive experiments  made  in  the  vasomotor  domain  seem  to  have  ex- 
cluded mechanical  irritation,  still,  I  must  confess  that  I  have  not  yet 
reached  a  final  judgment.  This  class  of  experiments  is  not  continued 
with  the  patient. 

The  importance  and  the  infrequency  of  the  phenomenon  in  question, 
which  forms  a  part  of  the  patient's  history,  constitute  my  excuse  for 
this  digression. 

October  2d  and  3d,  repetition  of  suggestions  against  onanistic  incli- 
nations. October  2d,  M.  masturbated  while  looking  at  a  picture  (Tann- 
hauser  in  the  Mountain  of  Venus),  though  since  the  first  sitting  the 
attacks  had  decreased  in  frequency.  October  3d  it  was  suggested  to 
her :  You  will  have  a  severe  pain  in  the  region  of  the  left  ovary  every 
time  you  attempt  to  masturbate,  and  will  be  able  to  overcome  the 
impulse.  The  following  three  days  there  was  not  a  single  attempt  to 
masturbate,  though  the  patient  remained  in  bed  until  10  A.M.  When,  on 
October  4th,  she  made  an  attempt  to  masturbate,  there  was  violent  pain 
in  the  left  ovary. 

From  October  8th  to  15th,  daily  repetition  of  the  therapeutic  sug- 
gestions ;  successful  suggestive  removal  of  the  anaesthesia  of  the  right 
arm;  no  more  onanistic  attacks.  October  16th,  relapse,  with  violent 
ovarian  pain.  From  October  16th  to  31st,  further  hypnotic  sittings 
without  relapse.  The  general  health  improves ;  nymphomaniacal  incli- 
nations have  been  absent  since  the  beginning  of  October. 

At  the  present  time  the  patient  ma}7  be  regarded  as  capable  of  fol- 
lowing her  employment,  and  has  begun  to  resume  it.  Her  sexual  l^per- 
aesthesia  is  much  diminished  ;  her  general  physical  and  mental  state  is 
essentially  improved  ;  the  inclination  to  onanism  has  decreased.  The 
patient  is  still  treated  intermittently. 

At  this  period  it  may  be  stated  with  exact  certainty  that  the  im- 
provement, in  the  sense  of  a  relative  cure,  is  to  be  ascribed  to  hj-pnotic 
treatment. 

December  15th.  The  patient  is  to  be  regarded  as  completely  cured 
of  nymphomania.  She  does  not  practice  onanism  any  more,  but  at  the 
time  of  the  menses  she  is  excitable  sexually,  and,  to  avoid  a  relapse,  at 
these  times  it  is  necessary  to  treat  her  prophylactically. 

March  10,  1892.  The  cure  of  the  onanism  in  about  forty  hypnotic 
sittings  is  complete.  No  relapse  anticipated.  The  patient  is  still  under 
treatment. 


SATYRIASIS   AND   NYMPHOMANIA. 


73 


I 

&  S   w  >       §     g<g     S-     §    c^     S     ^f^0'    -P'tWcS     «o    ^oor1    f°  » 

"   ^  "  '        ,?  j*  *  •  j*             -rt         ^      p°  '  *  *     &    ?  S* 

CASES. 

flt                               K^K-K^K^S^^^^^*^               t^t^E^ 

?    1      ^Iffffffffff  &&l|  §•»!  I    II  1 

o        2-          ^^o^^So^^p-'S-ETcc        ecc 

B 

2 
i 

» 

s                                          Pr3Ftrfrfrl'rt' 

CD 

. 

Male. 

00 

H 

Kk 

)-"             .                     I-"        l->.          .                h-. 

Female. 

OS 

.                  .                        »-»        >—.     .           I-"              >-'!-'        t-t 

1-10. 

o 

H 

» 

\     '.      M  :  M  :   :   :  M  M«  M*.  :  :  :   :     :  :   : 

10-20. 

00 

l-i              M                     .           »-•.           I-"        H-        t-"        K-l—        .                  ... 

20-30. 

• 

•     :      :::::::::::::::     ::  : 

30-80. 

£ 

.IV                                                                  Q3                       ,_!                                  -    |              „-                                  t£                       t—  *IOH^CO 

O            M                 li       CntO      OS       O       to       CO       C-.WX>4-       h'OOO       -o            COCn       CO 

Sittings. 

• 

:     •      •;:::::::::::::     ::  : 

Somnolence. 

o> 

Hypotaxis. 

t: 

-    :      i-  :  :   :   :   •-  ;   :  •—  -•-  ~'.~'.     MM  M 

Somnambulism. 

M 

Failure. 

,_, 

h-  » 

:     :      :::::::::::-::      :  :  : 

Temporary. 

IMPROVE- 
MENT. 

Cn 

:     :      :  ~~  :  :   :  :  —  :  :   :  :  -     :  :  : 

Great. 

CO 

F'th'r  Co'rse 
Unknown. 

5 

,_,             ,_,                  (^        .     .          I-"       I-"       (-"       I-"        .          l-ih-        .     .                                 .     .          »-" 

With  Later 
Report. 

CURE. 

CO 

.1-"                              •-')-' 

Without 
Later  Report. 

*. 

"     »-•       '                                            M       *               M*                                 *    *          M 

Relapse. 

• 

o'S'S                o2    "<s    s'*    c§'0Mg^>3    g     »pp             cS^SLp' 

"*  *  1            i."   °   '  3    w<jq~3i§'5  H  Sfsi'         'si^'i 

III      f  *  1  i'  lisps  I  '  s!     fifffj 
r^      I  1  li'lMtl  i     lilt 

"  —                       ct-  fl>      a          £*.    j  J      M      5s      ®      O         rio                           8s  <t  w  _ 

o^                 M.O-    ?         o    'a    B     X    »•    •=*       WS                 u^^S. 

*i           s     -•     g  e.  §   s,  2.  o     ^g           »§^S 
2.B-             ^ojS      o.Saql'g'      5*8 

H  S.     P<           1     •     S             B      a          2jl                     O-S-OD 
•dg^                   QC'          Sn             ".     °      o             S                    £  S1     S-' 

p'o                                     p           a    o     5              o                     «»3    ^ 

SB                 *           ?         ?    S    S            S                 5'     o 

• 
REMARKS. 

74  SEXUAL   HYPERjESTHESIA. 

CONCLUDING  REMARKS. 
The  foregoing  table  gives  the  following  results : — 

Cured,  with  subsequent  report,     .     10 

(2  still  treated  prophylactically  ; 

1  /  J  '  13=   65  per  cent. 

1  case  with  relapse.) 

Cured,  without  subsequent  report,      3 

Greatly  improved, 5=   25  per  cent. 

(3  with  subsequent   report ;    1 

case   still   under   treatment ;    1 

case  relapsed.) 

Temporary  improvement, 1  =      5  per  cent. 

Complete  failure, 1  =     5  per  cent. 

20      100  per  cent. 

Of  the  20  cases  of  onanism  (among  which  the  cases  of 
satyriasis  and  nymphomania  are  reckoned),  1 1  passed  into  som- 
nambulism, 6  into  hypotaxis,  and  in  3  cases  no  degree  of  hyp- 
nosis is  given.  The  number  of  hypnotic  sittings  extends  from 
3  to  152.  Of  the  20  cases,  10  were  completely  cured,  with 
subsequent  reports;  3  without  later  reports, — in  all,  13  cures. 
In  addition,  3  were  lastingly  improved,  with  subsequent  re- 
ports. According  to  this,  the  probability  of  lasting  cure  of 
onanism  or  sexual  hyperaesthesia  by  hypnotic  suggestion  may 
be  expressed  as  65  per  cent. ;  the  probability  of  some  success, 
as  90  per  cent. 

For  the  sake  of  a  rSsiime,  the  two  cases  of  satyriasis  and 
nymphomania  in  which  onanism  plays  an  important  part  were 
included. 

•  The  great  susceptibility  of  onanists  to  hypnosis  seems  re- 
markable, of  whom  eleven  passed  into  somnambulism.  This 
is  in  part  due  to  the  youth  of  the  patients.  But  even  the 
milder  degree  of  hypnosis  does  not  prejudice  the  result,  as 
Case  14  shows.  In  spite  of  the  seventy  sittings,  the  patient 
did  not  go  beyond  the  second  stage ;  yet  the  therapeutic  effect 
is  among  the  best  obtained. 

Owing  to  the  great  excitability  of  hysterical  and  neuras- 
thenic persons,  the  first  attempt  to  hypnotize  them  is  not  always 
successful.  In  Case  20  the  patient  could  not  be  hypnotized  on 


CONCLUDING    REMARKS.  75 

the  first  trial,  owing  to  an  intense  degree  of  psychical  erethism. 
Only  after  she  had  seen  several  hypnotized  patients  did  she 
have  a  desire  to  be  hypnotized.  I  artfully  increased  this  desire 
by  having  her  come  several  times  £,nd  making  her  wait  for  a 
long  time,  so  that  her  requests  became  more  urgent.  I  thus 
induced  a  favorable  psychical  predisposition,  and  at  the  second 
attempt  she  passed  immediately  into  somnambulism. 

In  Case  18  several  physicians  had  previously  made 
attempts  to  induce  hypnosis,  but  without  success,  because 
she  laughed  at  them.  Slight  hypo  taxis  at  the  first  trial.  I 
regularly  allowed  the  patient  to  lie  asleep  for  half  an  hour,  as 
a  result  of  which  the  hypnosis  gradually  deepened,  so  that  later 
deep  somnambulism  always  occurred.  Owing  to  the  apathy 
which  excessive  onanists  show  for  all  impressions,  suggestibility 
is  much  diminished,  and  Case  18  shows  that  the  depth  of  hyp- 
nosis, in  spite  of  the  existing  rapport^  does  not  always  correspond 
with  the  degree  of  suggestibility. 

The  more  the  patients  are  accustomed  to  masturbate  auto- 
matically, as  in  sleep,  the  more  difficult  it  is  to  affect  them.  In 
such  cases  we  cannot  dispense  entirely  with  other  therapeutic 
measures.  Appropriate  bandages,  belts  to  prevent  masturba- 
tion, etc.,  are  of  the  greatest  service  in  such  cases.  Berillon 
has  also  lately  advocated  this  view,  he  having  successfully 
treated  about  thirty  cases  of  confirmed  onanism  by  suggestion.1 
It  is  also  well,  where  the  patients  present  erethism,  to  prepare 
them  for  hypnosis  by  large  doses  of  bromides.  At  least,  I  was 
repeatedly  successful  in  deepening  the  hypnosis  by  this  means. 
In  addition,  general  treatment  of  the  nervous  system — for  ex- 
ample, by  hydro-therapeutic  procedures — should  not  be  spared. 

Case  15  demonstrates  beautifully  that  suggestion  may 
force  its  way  into  the  patient's  mind  in  a  state  of  complete  con- 

1  Cotnp.  Revue  de  I'hypnotisme,  Dec.,  1891,  p.  180.  In  the  reported  discussion  of  a 
paper  by  Professor  Bernheim,  Dumontpallier  and  Gorodichze  report  cures  of  severe  cases  of 
onanism  by  means  of  psycho-therapeutic  treatment.  Since  the  article  mentioned  appeared 
after  the  conclusion  of  this  work,  the  cases  could  not  be  considered  in  detail.  The  same 
Is  true  of  a  case  mentioned  by  Schmidkunz  in  his  work,  "  Psychologic  der  Suggestion" 
(Enke,  Stuttgart,  1892,  p.  398).'  The  case  is  one  of  involuntary  masturbation,  which  was 
successfully  treated  in  four  hypnotic  sittings  by  Dr.  G.  The  patient  was  able  to  overcome 
later  relapses  partly  by  means  of  auto-suggestion  and  partly  by  mechanical  means. 


76  SEXUAL     HYPEILESTHESIA. 

sciousness,  though  the  patient  thought  that  he  had  held  his  arm 
cataleptic  merely  to  please.  It  is  also  well,  in  good  somnambu- 
lists, to  give  the  suggestion  that  pain  will  occur  upon  the  first 
attempt  to  masturbate.  Case  20  gives  a  noteworthy  proof  of 
this. 

The  more  the  onanistic  habit  is  the  result  of  hereditary 
disposition  or  of  an  existing  psychopathic  condition,  the  more 
difficult  the  therapeutic  task  and  the  more  unfavorable  the 
prognosis.  Thus,  in  the  single  case  of  complete  failure  (Case  5), 
the  patient  was  an  imbecile ;  and  in  Case  7,  in  which  there  was 
but  slight  temporary  improvement,  there  was  marked  heredi- 
tary disposition,  for  the  father  was  likewise  an  onanist,  and 
there  were  several  other  symptoms  of  hereditary  taint. 

One  case  of  melancholia  masturbatoria  with  beginning 
dementia  I  had  to  refuse  as  inappropriate  for  hypnotic  treat- 
ment. Onanism  had  been  practiced  more  than  thirty  years, 
and  there  was  hereditary  disposition.  The  age  of  the  patient 
(female),  her  absent-mindedness,  and  her  mental  decay  contra- 
indicated  the  use  of  hypnosis.  Since  no  attempt  at  hypnosis 
was  made  with  this  patient,  her  case  is  not  included  in  the 
report. 

In  none  of  the  cases  reported  was  there  any  injurious 
effect  attributable  to  hypnosis.  Of  course,  the  cases  are  reported 
by  recognized  specialists  in  suggestive  therapeutics.  On  the 
other  hand,  I  was  able  to  observe,  in  several  cases,  that  the 
hours  of  relatively  the  best  condition  were  those  immediately 
succeeding  hypnosis.  These  favorable  intervals  increased  in 
length,  in  the  course  of  treatment,  from  several  hours  to  half  a 
day,  then  to  several  days. 

Without  regarding  hypnosis  as  a  universal  remedy  for 
onanists,  I  think,  from  the  practical  experiences  confirming  our 
theoretical  considerations,  that  we  may  conclude  that,  with 
reference  to  certainty  and  rapidity  of  effect,  as  well  as  with 
reference  to  the  permanence  of  success,  no  other  therapeutic 
method  has  given  similar  results  in  sexual  hyperaesthesia.  As 
little  as  we  can  dispense  with  other  means  as  a  supplement,  the 
application  of  suggestion  seems  to  me  to  be,  to  a  certain  extent, 


CONCLUDING   REMARKS.  77 

indicated  as  a  specific  remedy,  since  abnormal  symptoms  in  the 
domain  of  thought  and  instinct,  in  cases  of  sexual  hyperaes- 
tbesia,  especially  in  the  form  of  onariism,  may  thus  be  cor- 
rected. If  other  means  and  methods  are  not  successful,  then 
failure  to  use  suggestive  therapeutics  out  of  prejudice  and 
ignorance  must  be  regarded  as  inexcusable  negligence  on  the 
part  of  the  physician  toward  his  patients. 


II.  SEXUAL  IMPOTENCE  AND  ANESTHESIA. 


CHAPTER  IV. 
PATHOLOGICAL   CONSIDERATIONS. 

BY  impotence  we  understand  complete  or  partial  defect  of 
power  to  perform  coitus  in  a  normal  way  with  an  individual  of 
the  opposite  sex.1  This  is  called  impotentia  cceundi,  in  con- 
trast with  impotentia  generandi,  which  relates  to  the  fertility  of 
the  semen. 

Physiology. — The  experiments  of  Eckhard2  and  Goltz3 
have  demonstrated  the  interrelationship  of  the  cerebral  cortex 
and  the  sexual  organs.  The  impulses  necessary  for  erection 
arise  in  the  cerebrum,  and  pass  through  the  crura  and  pons  to 
the  spinal  cord.  The  erection-centre  in  the  lumbar  portion  of 
the  cord  may  be  excited  by  cerebral  (sexual  ideas  and  percep- 
tions), spinal  (stimulation  of  the  conducting  paths  in  the  cord), 
and  peripheral  stimuli  (reflex  irritation  from  the  glans  penis). 
Ideas  and  sensory  impressions  constitute  the  most  frequent  form 
of  excitation.  The  erection-centre  in  the  lumbar  portion  of  the 
cord  is  likewise  subject  to  inhibitory  influences  arising  in  the 
brain.  In  dogs,  section  of  the  cord  between  the  dorsal  and 
lumbar  regions  allows  more  prompt  and  rapid  occurrence  of 
erection.  Unpleasant  cerebral  excitement  (fear  of  failure  in 
coitus)  intensifies  the  effect  of  the  inhibitory  nerves,  i.e.,  hinders 
erection.  The  accessions  of  blood  to  the  corpora  cavernosa  of 
the  penis,  to  which  erection  is  due,  is  regulated  by  the  contrac- 
tion and  relaxation  of  the  organic  (involuntary)  muscular  fibres 
of  the  tissue :  the  nervi  erigentes  relax  the  muscular  fibres  and 
the  spaces  fill  with  blood.  Contraction  of  the  ischio-cavernosus 
muscles  compresses  the  penis  near  the  symphysis  pubis,  so  that 
the  backward  flow  of  blood  is  impeded ;  and  these  muscles 

1  Comp.  Caspar,  loc.  cit.,  p.  3. 

8  Beitrage  zur  Anatomic  und  Physiologic,  Bd.  ill,  iv,  vli. 

1  Pfliiger's  Archiv,  Bd.  vlli. 

(78) 


PATHOLOGICAL   CONSIDERATIONS.  79 

elevate  the  penis,  and  erection  occurs.  After  ejaculation  the 
muscles  relax  and  the  penis  collapses.  The  distended  bladder 
may  oppose  the  return-flow  of  blood  (morning  erections). 
When  there  is  insufficiency  of  the  muscular  apparatus,  there 
is  premature  return  of  blood,  resulting  in  partial  relaxation  of 
the  organ. 

Causes  and  Forms  of  Impotence. — Sexual  power  may  be 
interfered  with  by  the  most  various  circumstances.  The  phys- 
ical mechanism  of  the  sexual  act  requires  a  normal  condition 
in  all  the  parts  concerned  in  it.  Congenital  or  acquired  faults 
or  defects  of  the  sexual  organs  may  cause  impotence  (impotentia 
coeundi  e  defectus  seu  deformatione  *) :  for  example,  injuries  of 
the  brain  or  spinal  cord.  Consecutively,  other  serious  maladies, 
like  diabetes,  anaemia,  obesity,  etc.,  may  lead  to  it.  Alteration 
of  sexual  power  takes  place  as  a  result  of  toxic  influences 
(alcohol,  nicotine,  opium,  etc.). 

The  organic  changes  which,  as  a  result  of  anatomical 
lesions  of  the  muscular  or  nervous  parts  of  the  genital  appa- 
ratus, or  of  the  nervous  centres  and  paths  which  control  erec- 
tion, become  the  causes  of  impotence,  should  be  mentioned  here 
merely  for  the  sake  of  completeness ;  for  our  purpose,  however, 
they  are  important  only  in  that  in  such  conditions  there  can  be 
no  thought  of  therapeutic  effect  by  psychical  means.  In  a 
wider  sense,  congenital  anaesthesia  sexualis  belongs  here, — abso- 
lute defect  of  sexual  instinct,  notwithstanding  normal  develop- 
ment of  sexual  organs.2  According  to  von  Krafft-Ebing,  a  milder 
form  of  this  defect  is  presented  in  the  so-called  "  naturae  frigidae," 
who  show  disinclination  or  very  slight  inclination «for  sexual  in- 
tercourse, and  experience  no  lustful  or  psychical  excitement  in 
coitus.  Whether  such  cases  are  amenable  to  psychical  treat- 
ment remains  to  be  seen  ;  at  any  rate,  the  original  condition 
sets  the  natural  limits  for  the  possibility  of  improvement. 

What  is  true  in  the  case  of  congenital  anaesthesia  also 
holds  good  in  the  case  of  acquired  anaesthesia,  when  the  latter 
is  the  result  of  degeneration  of  the  nervous  conducting  paths 

1  Caspar,  loc.  cit.,  p.  11. 

3  Comp.  Pay.  Sexualis,  p.  31 ;  Hammond,  p.  2. 


80  SEXUAL   IMPOTENCE    AND    ANESTHESIA. 

and  the  genito-spinal  centres  as  a  result  of  castration,  atrophy 
of  the  testicles,  or  central  lesions  (paretic  dementia).  On  the 
other  hand,  cases  of  diminished  or  temporary  absence  of  libido, 
belonging  to  this  class,  form  the  transition  to  the  forms  of 
impotence  to  be  discussed  later. 

Hereditary  disposition,  physical  condition,  and  age  play  a 
predisposing  part  in  the  occurrence  of  impotence.  The  sexual 
power  begins,  on  an  average,  in  males  at  the  age  of  18;  in 
females,  in  our  climate,  at  the  age  of  16,  sometimes  a  year 
earlier.  After  the  age  of  40  sexual  power  diminishes,  and  is 
extinguished  in  men  at  the  age  of  65,  in  women  at  the  age  of 
50.  There  are  exceptions  to  this,  in  accordance  with  individ- 
uality and  constitution. 

Hereditary  predisposition  to  impotence,  with  respect  to 
intercourse  with  the  opposite  sex,  is  found  in  persons  of  con- 
trary sexuality.  Such  cases  are  repeatedly  described  under  the 
term  "Impotence,"1  and  in  monographs  on  "Impotence"  are 
usually  considered.  This  class  of  psycho-sexual  diseases,  be- 
longing to  relative  impotence,  will,  owing  to  their  great  practical 
importance,  be  given  separate  consideration  in  Section  III,  and 
therefore  no  further  reference  is  made  to  them  here. 

Fiirbinger2  examined  200  cases  of  impotence,  aged  from 
18  to  52,  and  found  that  50  per  cent,  of  all  cases  occurred  in 
the  fourth  decade  of  life.  All  these  cases  were  from  private 
practice;  on  the  other  hand,  out  of  15,000  patients  treated  at 
Friedrichshain  during  the  last  three  years,  only  two  came  for 
defective  facultas  coeundi.  Among  such  patients  young  single 
men  exceed  married  men  in  number.  Officers,  merchants,  and 
physicians  make  up  the  largest  contingent;  theologians  and 
teachers  the  smallest.  The  cause  was,  in  28  per  cent.,  onanism ; 
in  38  per  cent.,  gonorrhoea;  in  13  per  cent.,  both  of  these  fac- 
tors ;  10  per  cent,  were  given  to  great  excess  in  venery.  In 
accordance  with  these  figures,  89  per  cent,  of  cases  of  impotence 
occurred  in  patients  who  attributed  their  malady  to  onanism, 

*  Comp.  Leonpacher,  "  P»y.  Impotenz,"  Friedreich's  Blatter  fiir  gericht.  Medizin., 
1887,  p.  290. 

*  "  Ueber  Impotentia  virilis,"  Med.  chirurg.  Rundschau,  1890,  p.  188. 


PATHOLOGICAL   CONSIDERATIONS.  81 

gonorrhoea,  and  excesses.  Only  10  per  cent,  showed  a  blame- 
less* past  life.  Fiirbinger  was  also  able  to  note  variation  of 
sexual  power  in  the  same  individual,  in  accordance  with  physical 
and  mental  conditions  and  external  circumstances.  I  can  con- 
firm this  observation  from  my  own  experience.  As  a  rule,  im- 
potence goes  hand  in  hand  with  neurasthenia.  "  It  may  be  the 
only  symptom  of  neurasthenia"  (Fiirbinger).  For  this  reason 
it  is  difficult  to  separate  impotentia  coeundi  psychica  from  impo- 
tentia  cceundi  nervosa  irritativa  (sexual  neurasthenia),  as  Cas- 
par 1  does,  even  though  it  must  be  allowed  that  this  distinction, 
in  accordance  with  the  predominance  of  symptoms  of  sexual 
neurasthenia,  or  purely  psychical  symptoms,  is  practically 
useful. 

In  pure  functional  disturbances  of  virility  the  condition  of 
the  external  genitals  is  negative,  though  sensory  disturbances 
in  the  glans  may  be  discovered, — frequently  hypersesthesia.  The 
functions  which  go  to  make  up  the  sexual  act  may  be  disturbed 
singly  or  in  various  combinations  : — 

1.  Erection   may  be  incomplete  or  wanting,  so  that  the 
member  becomes  lax  ante-introitum  or  after  immission. 

2.  Ejaculation  may  be  premature,  too  quick  (praecox),  or 
delayed,  and  take  place  with  insufficient  ejection  of  semen. 

3.  Orgasm  may  be  diminished,  and  it  is  seldom  intensified. 

4.  Libido  sexualis  may  be  diminished  or  increased. 

In  accordance  as  1,  2,  3,  or  4  occurs  alone  or  in  various 
combinations  with  the  others,  we  have  various  varieties.  Thus, 
for  example,  we  may  have  libido  sexualis  increased  and  power 
of  erection  simultaneously  diminished ;  or  ejaculation  and  or- 
gasm may  be  interfered  with  where  libido  and  erection  are 
normal ;  or  libido  may  be  almost  extinguished  and,  power  of 
erection  being  retained  to  a  certain  extent,  erection  occurs  from 
peripheral  stimulation,  with  ejaculation  which  is  nearly  normal. 
Fiirbinger  saw  cases  of -the  latter  character. 

The  forms  of  impotence  may  be  classified  in  accordance 
with  other  peculiarities,  as  total  and  partial,  constant  and  tem- 
porary,  absolute  and  relative,  original  and  consecutive,  depending 

1  Loc.  c«.,p.  11 
6 


82  SEXUAL   IMPOTENCE    AND    ANAESTHESIA. 

upon  the  view  of  the  case  held.  In  partial  impotence  one  or 
more  of  the  factors  just  mentioned  are  intact.  Constant. im- 
potence signifies  defective  power  with  woman  at  all  times ;  the 
temporary  form  is  that  in  which  there  is  occasional  failure  of 
erection, — for  example,  as  a  result  of  intense  preoccupation  of 
the  mind  by  urgent  business  or  of  occasional  mental  preoccu- 
pation. According  to  his  contemporaries,  Newton  was  constantly 
affected  with  the  latter  form.  This  form  has  also  been  called 
real  psychical  impotence,  or  moral  or  hypochondriacal  impotence. 
It  presumes  increased  excitability  of  the  inhibitory  centre.  A 
thought,  a  doubt,  concerning  the  successful  performance  of 
coitus  is  sufficient  to  destroy  erection.  Cases  are  not  infrequent 
where  young  married  men,  who  have  had  intercourse  before 
marriage  only  with  votaries  of  Venus,  are  impotent  in  the  mar- 
riage-bed. The  absence  of  approach  on  the  part  of  the  young 
wife  on  the  one  hand  and  the  fear  of  exposure  on  the  other 
excite  the  inhibitory  mechanism.  As  has  been  before  men- 
tioned (Section  I),  intense  preoccupation  with  abstract  subjects 
(e.g.,  mathematics)  lias  a  paralyzing  effect  on  the  sexual  function. 

Absolute  impotence  means  that  the  patient  is  impotent 
alike  for  all  women,  while  relative  impotence  is  applied  to  cases 
where  the  defect  is  manifested  only  with  respect  to  certain  per- 
sons ;  like  those  young  husbands  who  can  have  intercourse  with 
a  puella,  but  not  with  their  wives.  There  are  also  married  men 
who  are  impotent  outside  of  marriage  relations,  probably  as  a 
result  of  the  custom  of  intensified  association  of  ideas.  There 
are  also  men  who  can  perform  coitus  under  definite  circum- 
stances,— for  example,  with  dressed  women, — while  they  are 
absolutely  impotent  with  a  nude  puella. 

Not  only  mental,  but  also  severe  physical,  labor  and  great 
fatigue  may  induce  temporary  impotence.  Gyurkovechky1 
speaks  of  an  occupation  impotence.  Thus,  according  to  him, 
book-worms  are  weak  in  sexualibus.  "With  intense  mental 
activity  the  thinking  portions  of  the  central  nervous  system  are 
thus  exercised  at  the  expense  of  the  sensory  and  motor  por- 
tions and  consecutively  developed." 

1  Loc.  cU.,p.  182. 


PATHOLOGICAL   CONSIDERATIONS.  83 

Sensuality  and  virility,  in  accordance  with  the  foregoing 
scheme,  may  stand  in  a  certain  contradiction  to  each  other,  in 
such  cases  as  are  most  frequently  observed  among  artists  and 
men  of  learning, — painters,  actors,  authors,  physicians,  and 
professors.  Abstinence1  also  leads  to  impotence  (consecutive 
atrophy  of  the  testes),.  as  we  have  seen  in  the  preceding  section. 

The  original  form  of  impotence  is  found,  for  example,  in 
individuals  affected  with  congenital  sexual  weakness,  the  forms 
of  which  have  been  previously  mentioned.  Consecutive  impo- 
tence signifies  the  occurrence  of  a  functional  weakness  of  the 
muscular  and  nervous  apparatus  of  erection,  resulting  from 
general  neurasthenia  or  some  other  primary  disease. 

In  addition  to  this,  we  may  mention  the  form  of  impo- 
tence depending  upon  delusion,  and  due  to  groundless  imagina- 
tion, which  should  be  classified  as  belonging  to  the  psychoses. 
Hammond2  reports  a  case  of  hypochondriacal  mania,  in  which 
the  patient  imagined  that  his  genitals  degenerated,  while  in 
fact  they  were  perfectly  healthy. 

Functional  weakness  of  the  genital  reflex  arc  and  of  the 

1  The  results  of  abstinence  induced  by  erroneous  education  are  clearly  shown  by  the 
following  communication,  received  during  the  publication  of  this  work  from  the  brother 
of  the  subject  of  Case  67  :  At  the  age  of  15  years,  X.,  while  at  school,  made  an  attack  on 
a  servant-girl  (aged  22).  On  touching  her  person  he  had  an  ejaculation.  The  strict  disci 
pline  of  his  elder  married  brother  restrained  all  sexual  tendency  at  home.  While  serving 
his  apprenticeship  as  a  merchant,  owing  to  enforced  abstinence,  he  became  hyperexcited  sex- 
ually and  made  an  attempt  at  rape  ;  the  approach  of  persons  prevented  its  completion.  He 
fled.  After  his  return  to  a  large  city,  a  visit  to  a  brothel.  However,  he  found,  as  he  believed, 
that  his  virility  was  much  diminished  by  abstinence.  A  single  act  of  coitus  weakened  him  so 
that  he  was  forced  to  keep  his  bed  several  days.  Con  fession  and  a  violent  scene  at  home.  His 
brother  and  guardian  had  practiced  abstinence  until  marriage  (in  his  twenty-fifth  year)  with- 
out harm,  and  demanded  the  same  of  him.  Though  the  patient  felt  himself  in  the  right,  by 
energetic  self-control  he  practiced  abstinence  five  years.  During  the  first  nine  months  fre- 
quent tickling  sensation  in  the  glans.  Frequent  dreams  at  night,  with  pollutions,  which  grad- 
ually ceased.  While  bathing  he  accidentally  came  to  masturbate  (self-pollution),  which  he 
only  practiced  three  times.  He  found  that  this  weakened  him  still  more.  During  the 
latter  part  of  the  five  years  sexual  desire  gradually  disappeared  entirely,  and  after  absti- 
nence for  five  years  he  made  another  trial  in  a  brothel.  He  was  impotent,  and,  in  spite  of 
several  attempts,  remained  so  up  to  the  time  of  making  this  report,  though  not  yet  30 
years  old.  Accident  so  decreed  that  the  strict  guardian  and  brother  should  learn  the 
fruits  of  his  plan  of  education  on  the  same  day.  He  received,  almost  simultaneously, 
news  that  one  brother  had  begun  treatment  for  contrary  sexual  instinct,  and  that  the  other 
was  impotent  as  a  result  of  the  abstinence  he  had  enforced.  Owing  to  the  congenital  neu- 
ropathic disposition  of  both  these  patients,  their  sexual  education  should  have  been  most 
painstaking,  in  order  to  prevent  functional  disturbance. 

•Loc.  cit. 


84  SEXUAL   IMPOTENCE   AND    ANESTHESIA. 

muscular  and  nervous  apparatus  in  relation  to  it  may  result  in 
lasting  loss  of  sexual  power, — a  form  known  as  paralytic  impo- 
tence. On  the  other  hand,  when  it  represents  but  a  temporary 
exhaustion  of  nerve-cells,  it  is  called  atonic  impotence.1  In  the 
latter  form  there  is  erection  occasionally,  but  it  lasts  but  a  short 
time  and  is  insufficient  for  coitus. 

Impotence  in  the  Female  Sex. — Sexual  impotence  in 
women  is  far  less  frequently  the  object  of  the  physician's  treat- 
ment than  that  in  men.  The  lesser  intensity  of  the  sexual 
impulse  and  the  form  of  the  genitals  in  the  female  sex,  as  well 
as  natural  modesty,  are  probably  sufficient  to  account  for  this. 
Hammond2  justly  points  out  that  our  education  and  social  con- 
ditions effect  a  development  of  the  sexual  impulse  in  the  male 
sex  much  beyond  the  limits  demanded  by  the  interests  of  future 
generations ;  while,  on  the  contrary,  feminine  education  in  civil- 
ized lands  is  entirely  directed  to  restraining  and  limiting  sexual 
desire. 

As  in  the  male  sex,  organic  defects  (absence  or  incomplete 
development  of  the  clitoris)  may  cause  absence  or  diminution 
of  sexual  desire.  It  must  be  remembered,  however,  that  the 
mucous  membrane  of  the  vulva,  the  cervix,  and  the  os  uteri 
possesses  sensibility  similar  to  that  of  the  clitoris,  and  that 
therefore  the  operative  removal  of  the  clitoris  does  not  prevent 
lustful  excitement  (Hammond).  Congenital  defect  of  sexual 
instinct  (frigiditas  organica  idiopatliica),  according  to  Ham- 
mond, also  occurs,  though  it  is  exceedingly  rare. 

An  anomalous  formation  of  the  genitals  may  render  im- 
missio  penis  impossible,  and  thus  cause  impotence,  as  may 
acquired  anatomical  defects  (syphilitic  growths,  hernia  of  the 
labia  majora,  etc.). 

The  most  frequent  functional  hinderance  to  cohabitation  is 
vaginismus  (hypersesthesia  of  the  hymen  and  the  vulva,  with 
involuntary  spasmodic  contraction  of  the  sphincter  vaginas). 
Pain  and  spasm  make  the  sexual  intercourse  of  such  patients  a 
burden. 

Usually,  vaginismus  occurs  only  after  attempts  at  coitus  as 

1  Caspar,  loc.  tit.,  p.  75.  * Loc.  cit. 


PATHOLOGICAL   CONSIDERATIONS.  85 

a  result,  for  example,  of  spinal  irritation  or  hysteria,  but  most 
frequently  after  masturbation. 

Sexual  excesses  and  want  of  correspondence  in  the.  size  of 
the  genitals  also  play  a  part  in  its  etiology. 

The  most  frequent  form  of  impotence,  and  that  which  in  its 
practical  bearings  has  not  been  sufficiently  recognized,  is  that  due 
to  defect  or  absence  of  the  female  orgasm,  whether  it  be  due 
to  a  want  of  sympathy  with  the  husband  or  to  the  fact  that  the 
stimulus  caused  by  the  friction  of  the  penis,  with  complete 
desire  and  intense  sympathy,  is  not  sufficient  to  bring  on  the 
acme  of  the  sexual  paroxysm  in  the  woman.  The  man  has 
•already  passed  the  acme,  the  penis  becomes  relaxed,  while 
the  woman  is  still  in  a  state  of  strained  expectation  without 
having  experienced  the  characteristic  lustful  feeling.  This 
difficulty  in  the  occurrence  of  the  orgasm  may  be  congenital,  or 
— and  this  is  the  most  frequent  form — it  may  be  due  to  sexual 
excesses  and  masturbation,  or  to  local  disease,  as  after  childbirth. 
In  such  cases  there  is  exhaustion  of  related  central  ganglion- 
cells,  which  no  longer  react  promptly  to  the  stimulus.  Erec- 
tion of  the  clitoris  may  also  be  involved.  Finally,  lustful  sen- 
sation, just  as  in  the  male,  even  though  it  occur,  may  be 
weakened  and  remain  incomplete. 

The  forms  of  impotence  here  described  have  excited  a 
controversy  among  gynecologists  in  the  Archiv  fur  Gyna- 
Icologie?  the  TherapeutiscJie  Monatsheften?  and  the  Allege- 
meine  medicin.  Centralzeitung r,3  in  that  an  attempt  is  made  to 
regard  such  cases  as  "  perversions,"  and,  in  support  of  this  error, 
to  account  for  it  by  assuming  a  deviation  in  the  distribution 
of  the  nerves  of  lustful  sensation  like  the  hypothesis  of  some 
authors  (Mantegazza)  that  in  pederasts  the  terminal  branches 
of  the  pudic  nerve  are  distributed  to  the  rectum  and  anus.  Dr. 
Carl  Laker  gives  the  following  characteristics  of  the  peculiar 
sexual  perversion  of  the  female  described  by  him : — 

1  Archiv  f.  Gynakologie,  Bd.  xxxiv,  Heft  2,  1889,  p.  293.  Laker,  Ueber  eine  besondere 
Form  vou  verkehrter  Richtung  (Perversion)  des  weiblichen  Gesehlechtetriebes. 

a  Therapeutische  Monatsheften,  1890,  p.  165.  Dr.  Gustav  Leimann,  Ueber  Onanismus 
beim  Weib  als  einer  bes.  Form  von  verkehrter  Richtung  des  Geschlechtstriebes. 

1  Wiener  med.  Wochenschrift,  1889,  No?  28,  and  Allgem.  med.  Centralztg.,  1889,  p.  37. 
Franz  Torggler,  Casuistischer  Beitrage  zur  Perversion  des  weiblichen  Gesehlechtestriebes. 


86  SEXUAL   IMPOTENCE   AND   ANAESTHESIA. 

1.  Normally   developed   and   frequently  increased  sexual 
desire. 

2.  .Normal  inclination  toward  the  opposite  sex  and  absence 
of  any  pathological  inclination  toward  the  same  sex. 

3.  Complete  absence  of  sexual  satisfaction  in  normal  inter- 
course (never  has  been  experienced). 

4.  Complete  satisfaction  of  sexual  desire  in  solitary  and 
mutual  onanism. 

5.  Consciousness  of  the  abnormal  condition  and  desire  for 
a  cure. 

6.  Absence  of  states  of  psychical  degeneration. 
Laker  gives  three  cases  as  examples : — 

Case  1.  Sexual  inclinations  began  in  her  twelfth  year.  Sexual  in. 
tercourse  in  her  fifteenth  year  without  satisfaction.  Seduced  into  mutual 
onanism  by  friends  (several  months  later).  She  experienced  complete 
gratification.  Married  at  22  years  of  age.  Never  any  lustful  feeling  in 
coitus  ;  always  in  onanism.  This  patient  knew  several  who  suffered 
like  herself. 

Case  2.  Seduced  to  mutual  onanism  in  her  fourteenth  year.  Nat- 
ural intercourse  in  her  nineteenth  year,  without  lustful  pleasure.  In- 
creased libido.  Bore  two  children.  Owing  to  her  anomaly,  she  cannot 
bring  herself  to  marry  again. 

Case  3.  Seduced  to  onanism  at  the  age  of  11  j'ears.  Abnormally 
increased  desire.  Intercourse  with  several  men  without  ever  being  satis- 
fied by  coitus.  Orgasm  by  means  of  auto-masturbation.  According  to 
Laker's  experience,  this  form  is  quite  frequent  in  women.  To  explain 
the  anomaly,  the  author  assumes  the  existence  of  an  anatomical  devia- 
tion in  the  distribution  of  the  sensory  nerve-endings.  For  this  "  typical 
common  form"  he  recommends  local  surgical  treatment,  and  thinks  that 
perversion  of  the  sexual  instinct  may  develop  from  mutual  onanism. 

Franz  Torggler  confirms  Laker's  experience : — 

Case  4.  The  patient  was  seduced  to  onanism  in  her  fourteenth  year, 
and  was  a  slave  to  it  until  her  sixteenth  year.  Then  a  platonic  love- 
affair.  After  six  months'  acquaintance  with  her  lover,  mutual  onanism 
with  him,  which  gave  her  more  pleasure  when  the  clitoris  alone  was  stim- 
ulated than  when  the  vulva  and  vagina  were  manipulated.  Coitus  avoided 
for  social  reasons.  Seduction  in  her  eighteenth  }'ear.  Frequent  coitus  ; 
excessively-increased  sexual  desire  without  satisfaction  in  coitus ;  after 
every  attempt  at  coitus,  she  masturbated  in  order  to  experience  the  acme 
of  the  sexual  paroxysm.  After  the  relation  ended,  resort  to  onanism 


PATHOLOGICAL   CONSIDERATIONS.  87 

again.  Then  marriage  to  a  man  she  loved.  Again  no  satisfaction  in 
coitus.  She  then  came  to  place  her  hand  on  her  clitoris  during  the 
conjugal  act,  in  order  to  induce  orgasm  by  manipulation. 

Gustav  Loimann  gives  three  cases,  of  which  the  first  is 
essentially  like  those  reported.  The  second  case  is  instructive 
in  relation  to  explaining  the  anomaly,  and  for  that  reason  may 
be  repeated  briefly  here : — 

The  patient  menstruated  first  at  the  age  of  17;  marriage  at  20. 
Happy  married  life  for  ten  years.  Eight  children.  Complete  satisfac- 
tion in  coitus.  Widow  at  30.  Intense  sexual  desire ;  no  chance  to 
marry  again.  Faute  des  mieux,  onanism,  which  was  injurious  to  her 
mental  and  physical  health.  On  the  advice  of  a  physician,  she  entered 
into  a  relation  with  a  student,  aged  18,  who  had  been  entrusted  to  her 
care,  without  thought  of  consequences.  The  former  satisfaction  did 
not  occur.  She  attributed  this  to  the  inexperience  of  her  lover,  and 
sought  another  and  another.  The  desired  satisfaction  never  came,  but 
she  developed  a  chronic  vaginal  catarrh.  At  commencement  of  treat- 
ment masturbation  was  practiced  as  inordinately  as  before. 

In  its  principal  features,  the  third  case  is  similar  to  the 
second :  at  first  complete  satisfaction  in  marital  intercourse ; 
death  of  the  husband ;  onanism ;  later,  failure  of  orgasm  in 
coitus. 

Concerning  the  etiology  of  this  misunderstood  form  of  dis- 
ease, which,  according  to  the  statements  of  gynaecologists,  is 
frequent,  it  is  noteworthy  that  in  all  the  cases  reported,  with  the 
exception  of  the  first  by  Laker,  auto-masturbation  or  mutual 
onanism  preceded  the  defect  of  orgasm  in  coitus.  Loimann's 
patients,  as  far  as  the  sexual  paroxysm  was  concerned,  were 
potent  for  years  until  the  beginning  of  habitual  onanistic  in- 
dulgence. Through  frequent  unnatural  stimulation,  the  im- 
pressionability of  the  centres  influencing  lustful  feeling  in 
woman  is  greatly  altered  and  diminished  in  power  to  respond 
to  normal  stimulation, — a  fact  which  Loimann  has  correctly 
recognized.  In  every  instance  it  is  a  form  of  genuine  female 
impotence  in  which  the  orgasm  is  no  longer  induced  by  the 
sexual  act.  By  manual  friction  the  excitability  of  the  clitoris 
is  increased  as  compared  with  that  of  the  vaginal  mucous  mem- 
brane and  of  the  os  uteri,  and  that  without  necessity  to  assume 


88  SEXUAL  IMPOTENCE  AND  ANAESTHESIA. 

unequal  distribution  of  nerves  to  account  for  the  variation  of 
sensitiveness. 

The  question  whether  masturbation  by  means  of  objects 
resembling  the  penis  in  form,  and  which,  therefore,  do  not  stim- 
ulate the  clitoris  exclusively,  but  also  those  parts  of  the  vagina 
which  are  subjected  to  friction  in  coitus,  is  likewise  capable  of 
inducing  impotence,  cannot  be  answered  from  the  cases  at  hand. 
By  analogy,  it  might  be  presumed  that  this  form  of  stimulation 
could  not  cause  impotence  unless  male  ejaculations  were  to  take 
place  too  quickly.  Concerning  Laker's  first  case,  which  seems 
to  be  an  exception,  it  may  be  remarked  that  in  woman  lustful 
feeling  is  not  always  brought  about  by  the  first  coitus,  but  that 
it  occurs  sometimes  only  after  repetition  of  the  act.  In  accord- 
ance with  individual  peculiarity,  it  requires  a  longer  or  shorter 
time  before  the  various  phases  of  cohabitation  occur  in  a  normal 
way.  Loimann  saw  cases  in  which  marriage  led  to  complete 
satisfaction  only  after  many  months  or  after  childbearing.  I 
can  confirm  this  from  my  own  observation.  At  the  present 
time  I  am  treating  a  woman  in  pregnancy  (aged  17),  who,  in 
intercourse  during  several  months  with  her  seducer,  never  had 
lustful  feeling;  and  she  experienced  it  first,  after  the  occurrence 
of  pregnancy,  in  intercourse  with  another  man.  Another  patient 
assures  me  that  of  her  various  lovers  only  a  few  were  able  to 
induce  in  her  the  acme  of  the  sexual  paroxysm  in  coitus.  It  is 
the  same  with  prostitutes,  who  very  soon  pass  from  the  stage  of 
hyperaesthesia  to  that  of  anaesthesia  and  relative  impotence.1 

In  the  cases  described  by  Laker  it  is  to  be  considered  that 
auto-masturbation  began  only  a  few  months  after  defloration, 
with  which  the  pathogenesis  of  impotence  had  its  beginning. 
Finally,  want  of  satisfaction  in  the  concrete  case,  which  might 
be  explained  by  speedy  ejaculation  of  the  man  after  immissio 
penis,  is  to  be  strictly  distinguished  from  absolute  impossibility. 
One  of  my  patients  was  satisfied  by  her  husband  only  at  the 
beginning  of  married  life,  and  after  the  birth  of  her  child 

1  In  that  prostitution  usually  excludes  the  physiological  condition  of  the  sexual  rela- 
tion, namely,  excitation  of  love, — the  participation  of  the  psycho-sexual  centres  favorable 
for  normal  coitus  being  either  diminished  in  intensity  or  absolutely  impossible, — it  may 
be  regarded  as  pathological  and  classified  as  one  of  the  forms  of  impotence  described. 


PATHOLOGICAL   CONSIDERATIONS.  89 

remained  relatively  impotent  with  him,  while  she  was  fully 
satisfied  by  the  stronger  stimulus  of  coitus  with  another. 

In  many  women  orgasm  occurs  only  after  prolonged  coitus 
or  after  repetition  of  it  after  a  short  pause.  The  psychical  con- 
dition of  women  in  all  cases  of  impotence  requires  much  more 
careful  study  than  in  the  case  of  men.  Sexual  intercourse  in 
woman,  as  a  rule,  includes  a  much  more  intense  psychical  par- 
ticipation than  in  a  man.  "  A  woman  loves  with  her  whole 
soul.  To  her  love  is  life ;  to  a  man  it  is  the  joy  of  life."  Un- 
requited love  wounds  him,  but  it  costs  a  woman  her  life,  or,  at 
least,  her  happiness.  At  any  rate,  the  mental  tendency  of 
woman  is  monogamous,  while  man  tends  to  polygamy  (von 
Krafft-Ebing1).  Therefore  the  occurrence  of  relative  impotence 
in  women  should  be  much  more  frequent  than  in  men. 

The  pathological  explanation  of  female  impotence  is  often 
only  an  expression  to  cover  up  our  want  of  knowledge  of  the 
marital  relations.  We  are  not  able  to  ascertain  how  often  the 
wife's  disinclination  to  sexual  intercourse  and  her  apparent 
passiveness  are  due  to  the  sexual  weakness  of  the  husband, 
who  makes  it  impossible  for  the  wife  to  complete  the  act,  and 
thus,  by  nervous  excitement,  without  subsequent  completion  of 
it,  lays  the  foundation  of  nervous  troubles.  In  judging  female 
impotence,  we  must  also  take  into  consideration  the  decisive 
part  played  by  the.  sexual  functions  in  the  mental  life  and 
development  of  woman.  We  should  remember  the  numerous 
unhappy  marriages  brought  about  by  our  social  conditions,  the 
frequency  of  which,  according  to  the  statements  of  certain 
statisticians,  is  75  per  cent.  The  question  of  female  impotence, 
in  a  broader  sense,  touches  most  intimately  both  private  and 
social  life.  Upon  the  correct  judgment  of  the  physician,  which, 
in  the  case  of  women,  must  be  reached  after  the  most  careful 
psychological  analysis  of  the  sexual  life,  depends  the  happiness 
of  the  family  and  the  therapeutic  treatment.  This  often  makes 
heavier  demands  upon  the  psychiatrist  than  upon  the  gynae- 
cologist, who  looks  at  everything  through  the  spectacles  of  local 
anatomy.  Thus  may  be  explained  the  error  of  attempting  to 

1  Psychopathia  Sexualis,  p.  14. 


90  SEXUAL   IMPOTENCE    AND    ANAESTHESIA. 

make  a  new  class  of  sexual  perversions  out  of  cases  of  simple 
female  impotence. 

Diagnosis. — A  careful  local  examination  must  first  deter- 
mine with  what  form  of  impotence  the  patient  is  afflicted.  In 
the  majority  of  cases,  endoscopical  examination  of  the  urethra 
reveals  nothing.  The  majority  of  disturbances  of  the  sexual 
mechanism  are  thus  of  a  functional  nature,  and  reveal  them- 
selves, therefore,  in  the  subjective  sensations  and  observations 
of  the  patients.  The  discovery  of  the  cause  points  .out  the 
method  of  therapeutic  procedure.  In  making  a  diagnosis, 
attention  should  be  given  principally  to  constitution,  manner 
of  life,  and  the  state  of  the  nervous  system  in  general.  Often, 
signs  of  flaccidity  and  weakness  of  the  genitals  are  to  be  ob- 
served ;  for  example,  in  neurasthenia  sexualis  and  after  sexual 
excesses.  In  the  forms  of  impotence  resulting  from  abstinence, 
Gyurkovechky1  found  that  the  testicles  were  smaller  than  they 
formerly  were.  The  mental  condition  of  such  patients  requires 
the  most  study.  The  feeling  of  lustful  pleasure  may  be  altered 
or  entirely  absent  without  the  necessity,  for  that  reason,  to  call 
the  patient  directly  impotent.  If  the  fulfillment  of  marital 
duty  become  an  unpleasant  necessity,  or  if  the  sexual  act  with 
prostitutes  is  done  with  repugnance,  lustful  feeling  is  either 
much  diminished  or  absent.  There  are  persons  who  naturally 
possess  but  a  slight  degree  of  lustful  sensibility.  Individual 
disposition  and  the  intensification  of  sexual  desire  by  love 
determine  the  intensity  of  lustful  feeling. 

The  foregoing  points  may  be  extended  by  reference  to  the 
diagnosis  of  sexual  hypersesthesia  in  Section  I. 

The  prognosis  depends  upon  the  conditions  in  each  indi- 
vidual case.  Cases  of  impotence  due  to  organic  causes  are  to 
be  treated  locally,  and  are  not  amenable  to  psychical  thera- 
peutics. Congenital  defect  of  the  sexual  mechanism  permits 
only  a  doubtful  prognosis.  The  prognosis  in  cases  of  impotence 
due  to  abstinence  is  unfavorable  if  the  testicles  are  shrunken. 
In  consecutive  impotence  the  prognosis  depends  entirely  upon 
the  primary  disease.  Impotentia  nervosa  irritativa  presents 

1  Loc.  cit.,p.  138. 


PATHOLOGICAL   CONSIDERATIONS.  91 

* 

opportunity  for  treatment ;  for  example,  in  general  treatment  of 
the  nervous  system  and  in  the  effort  to  re-adjust  the  want  of 
relation  between  the  various  functions  which  make  up  the 
sexual  act.  Atonic  impotence  also  permits  complete  cure,  while 
in  the  paralytic  form  the  organic  changes  in  nerve-centres  and 
paths  which  control  erection  make  the  prognosis  unfavorable. 
In  psychical  impotence  it  should  first  be  determined  whether 
the  central  disturbance  is  primary,  or  secondary.  Gonorrhoea, 
diseases  of  the  prostate,  inflammation  of  the  testicles,  and 
onanism  affect  the  mind  secondarily ;  while  impotence  due  to 
imperative  ideas,  absent-mindedness,  etc.,  is  primary.  On  the 
whole,  in  the  cerebral  neuroses  the  prognosis  is  favorable,  if 
they  are  understood  and  treated  with  reference  to  their  etiology. 
At  the  same  time,  hereditary  disposition,  in  these  cases,  must 
also  be  taken  into  consideration  ;  acquired  psychical  impotence, 
in  the  absence  of  symptoms  of  other  serious  disease  of  the  ner- 
vous system,  offers  a  fertile  field  for  psycho-therapeutists.  Rela- 
tive impotence  in  married  persons,  for  example,  as  a  result  of 
lack  of  acquiescence  on  the  part  of  the  wife,  touches  delicate 
ground,  and  offers  prospect  of  success  only  in  cases  where  both 
parties  submit  to  systematic  psychical  treatment.  The  delusion 
of  impotence  belongs  in  the  domain  of  the  psychoses,  and  is  to 
be  judged  and  treated  from  that  stand-point. 


CHAPTER  V. 

THE  ROLE  OF  SUGGESTIVE  THERAPEUTICS  IN  THE 
TREATMENT  OF  FUNCTIONAL  SEXUAL  WEAKNESS. 

THE  causes  and  forms  of  impotence  determine  in  each  case 
the  direction  of  therapeutic  measures.  The  majority  of  sexual 
invalids  (according  to  Fiirbinger,  89  per  cent.)  attribute  their 
malady  to  sexual  excesses,  onanism,  and  gonorrhoea.  The 
principles  of  prophylaxis  here  are  exactly  the  same  as  those 
laid  down  in  the  pathological  states  described  in  Section  I 
(compare  what  has  been  said  concerning  sexual  education, 
page  34). 

Among  the  methods  of  treatment  in  vogue,  correct  hygi- 
enic measures  are  the  most  important.  The  most  important 
means  of  cure  is  rest  to  the  exhausted  genitals.  Coitus  must 
not  be  indulged  in  for  a  period  long  enough  to  permit  recovery. 
Sufficient  sleep  must  be  obtained,  and  diet  tending  to  produce 
superfluous  fat,  which  injures  sexual  power,  must  be  avoided, 
as  must  stimulants.  In  addition,  the  measures  described  in  the 
therapeutics  of  sexual  hyperaesthesia  are  indicated. 

If  there  are  symptoms  of  neurasthenia  universalis  (cerebral 
or  spinal),  general  treatment  (climatic,  hydro-therapeutic,  gym- 
nastic, electrical,  etc.)  is  advisable.  In  case  of  combination  of 
spermatorrhoea,  chronic  gonorrhoea,  etc.,  the  local  treatment  is 
given  in  so  much  detail  in  all  special  works  on  impotence  that 
it  is  unnecessary  to  consider  it  further  here.  Concerning  strict 
individualization  in  the  application  of  balneo-hydro-therapeutical 
measures,  consult  the  foregoing  section  and  special  works ;  also 
for  the  various  methods  of  application  of  electrical  currents, 
which,  locally  as  well  as  generally,  may  have  the  happiest  effect ; 
for  example,  in  anaesthesia  of  the  glans,  in  the  beginning  of  atro- 
phy of  the  testicles.1  Electricity  in  the  treatment  of  impotence  is 
also  indispensable  to  the  psycho-therapeutist.  Here  it  is  only 
necessary  to  refer  to  the  medicaments  that  are  briefly  alluded  to 

1    1 1  :i  in  in  Mini,  loc.  tit. 

(92) 


FUNCTIONAL   SEXUAL   WEAKNESS.  93 

in  Section  I.  A  detailed  treatment  would  lead  us  away  from 
our  subject  and  be  but  a  repetition  of  what  is  familiar.  Gyur- 
kovechky '  thinks  that  medicaments  are  not  the  means  in  the 
treatment  of  impotence  which  most  frequently  and  surely  lead 
to  success.  And  Hammond  compares  the  effect  of  substances 
of  various  properties  in  many  forms  of  impotence  with  that  of 
bread-pills.  However,  we  must  here  examine  one  method  of 
treatment  which  of  late  years,  especially  among  French  writers, 
has  led  to  much  discussion,  viz.,  Brown-Sequard's  method  of 
treating  impotence.2 

The  subcutaneous  injection  of  the  testicular  juice  of  various 
animals  in  the  impotence  of  males,  according  to  the  assertion 
of  the  celebrated  physiologist,  exerts  a  favorable  influence  upon 
diminished  sexual  power.  There  is  said  to  be  an  effective  prin- 
ciple in  the  semen  that  is  capable  of  stimulating  great  power. 
Brown-Sequard  attributed  the  loss  of  virility  in  old  men  to  the 
diminished  activity  of  the  testicles.  He  (aged  72)  injected  on 
himself  during  three  weeks  an  extract  of  testicular  juice  ten 
times.  This  painful  procedure  had  a  favorable  effect  upon  him, 
troubled  as  he  was  by  the  weaknesses  of  old  age.  "In  place 
of  states  of  exhaustion  came  a  feeling  of  strength  like  that  of 
twenty  years  before.  Again,  he  was  able  to  stand  without 
fatigue  for  hours.  Muscular  power,  measured  with  a  dyna- 
mometer, showed  a  decided  increase.  The  stream  of  urine  was 
stronger  and  of  greater  length.  Defecation  was  essentially 
stronger.  After  four  weeks  the  old  conditions  of  weakness  re- 
turned." Variot  observed  the  favorable  effect  on  the  sexual 
functions  in  five  men.  An  extract  from  the  ovaries,  it  was  pre- 
sumed, would  have  a  similar  favorable  effect  in  women.  Though 
numerous  objections  were  offered  to  this  theory,  by  assuming 
that  suggestion  and  peripheral  irritation  through  pain  played  a 
part  in  the  results  (Fere  and  Dumontpallier),  Brown-Sequard's 
reports  fell  on  fertile  soil.  Chemists  sought  to  isolate  the  active 
principle  of  sperma  (Parke,  Davis  &  Co.);  it  was  called  sper- 
min  or  spermatin  (Schreiner).  The  newspapers  hailed  Brown- 

1  Loc.  cit.,  p.  163. 

1  Fiirbinger,  "  Zur  Wnrdigung  der  Brown-S6quard'schen  Beliandlung  der  Impo- 
tenz,"  Deutsche  med.-Ztg.,  vom.  22,  Juni,  1891,  p.  583. 


94  SEXUAL   IMPOTENCE    AND    ANAESTHESIA. 

Sequard's  discovery  as  the  givei  of  perpetual  youth.  And  a 
year  later  the  discoverer  himself  was  forced  to  flee  to  England 
to  escape  from  the  impotent  horde  that  assailed  him. 

A  great  and  celebrated  manufactory  applied  to  Fiirbinger, 
as  he  states,  to  obtain  the  testicles  of  all  men  subjected  to 
autopsy  in  the  hospitals  of  Friedrichshain,  in  order  that  they 
might  meet  the  demand  for  spermatin.  Later,  Brown-Sequard 
recommended  the  use  of  the  testicular  fluid  by  enema  as  pro- 
ducing wonderful  results.  Reaction  was  not  wanting.  The 
better  representatives  of  medical  literature,  even  in  France,  kept 
silent.  Against  his  inclination,  Fiirbinger  at  last  decided  to 
test  the  new  method  of  treatment.  In  order  to  eliminate  the 
psychical  factor,  Fiirbinger  took  old  men  and  patients  from  the 
lower  classes  who  were  not  acquainted  with  the  object  of  the 
treatment.  He  mixed  fresh  semen  of  healthy  men  with  five 
times  its  amount  of  a  solution  of  thymol,  added  a  drop  of  potas- 
sium hydrate,  boiled,  and  then  filtered  the  whole.  The  solution 
was  then  used  for  injection.  He  treated  eighteen  men,  aged 
from  24  to  72  years,  and  patients  or  old  men  affected  with  skin 
diseases,  rheumatism,  etc.  In  three  days  the  injections  were 
increased  to  five.  In  one-half  the  cases  pain  occurred  at  the 
seat  of  injection  ;  once  violent  inflammation  was  induced.  Four 
patients  felt  depressed.  Two  consumptives  became  greatly 
excited  and  had  no  sleep.  "  Not  a  single  instance  of  sexual 
excitement  reported  or  confessed."  The  failure  of  this  test, 
according  to  Fiirbinger,  needs  no  comment.  According  to  these 
experiments,  the  exciting  and  youth-giving  power  of  Brown- 
Sequard's  treatment  seems  to  rest  upon  an  erroneous  assumption. 
All  the  effects  may  be  directly  attributed  to  auto-suggestion, 
as  Fiirbinger,  Forel,  and  others  assume. 

Psycho-therapeutics. — For  affecting  the  imagination  of  im- 
potent men,  there  could  hardly  be  a  more  effectual  psycho-thera- 
peutic procedure  than  this  of  a  belief  in  the  secret  and  youth- 
giving  effect  of  an  extract  of  the  testicles.  The  very  sexual 
origin  of  the  substance  awakens  hopes  and  intensifies  the 
patient's  expectation.  The  entire  attention  is  directed  to  the 
parts  diseased,  and  intensified  by  the  exciting  and  painful  injec- 


FUNCTIONAL    SEXUAL    WEAKNESS.  95 

tions.  The  patient  feels  something  taking  place  in  him ;  his 
faith  grows ;  the  mysterious  effect  of  the  youth-giving  juice 
excites  his  fancy  in  the  most  lively  fashion.  Let  us  remember 
that  the  cerebral  part  of  the  sexual  act  in  almost  all  cases  of 
impotence  also  suffers,  if  it  be  not  the  cause  alone  of  impo- 
tence !  Thus,  the  possibility  cannot  be  denied  that  these 
factors  may  overcome  the  psychical  functional  disturbance  and 
completely  cure  many  cases  of  impotence.  Other  means  used 
to  conceal  our  psycho- therapeutic  procedures  in  the  waking 
state  speak  in  favor  of  this  explanation. 

In  the  majority  of  cases  of  so-called  psychical  impotence, 
the  object  is  to  remove  the  influence  of  excited  brain  activity 
from  the  inhibitory  nerves.  If,  for  example,  it  is  possible  to 
demonstrate  to  the  patient  that  he  is  capable  of  an  erection,  the 
first  step  toward  recovery  has  been  taken.  The  patient's  self- 
confidence  is  thus  strengthened  in  the  most  marked  manner. 
Faradization  of  the  genitals;  the  use  of  larger  and  larger  metal 
sounds,  that  are  left  in  place  ten  or  fifteen  minutes ;  supposito- 
ries of  silver  and  tannin  in  the  posterior  urethra ;  clysters,  etc., 
induce  erection.  All  these  means,  like  Brown-Sequard's,  affect 
the  patient's  mind,  and  demonstrate  the  principles  of  psychical 
treatment  in  the  waking  state,  which  we  have  described  in  the 
treatment  of  sexual  hyperaesthesia.  Fear,  distrust,  superstition, 
hopelessness,  and  hypochondriacal  mood  often,  as  causes  of 
psychical  impotence,  present  insurmountable  difficulties.  Suc- 
cess with  such  patients  depends  entirely  upon  correct  individu- 
alization  and  the  acuteness  of  the  physician.  It  is  necessary  to 
so  influence  the  patient  that  he  is  not  constantly  pre-occupied 
with  himself;  that  he  takes  his  malady  and  any  possible  failure 
with  indifference.  Useless  sexual  excitement  (for  example,  with 
a  fiancee)  must  be  absolutely  avoided.  Every  forced  act  on  'the 
part  of  the  patient  paralyzes  the  erection-centre  only  the  more. 
Rest  of  mind  is  the  most  essential  thing  for  the  patient.  But 
one  must  be  careful  not  to  attempt  to  cure  a  real  disease  by 
argument ;  this  would  only  make  matters  worse.  The  phy- 
sician's task  is  to  have  a  well-considered  plan  for  the  cure  of 
the  patient  carried  out.  Cold  rubbing,  baths,  medicines,  and 


96  SEXUAL   IMPOTENCE   AND   ANAESTHESIA. 

local  treatment  must  conceal  the  method  of  cure.  The  patient 
must  gain  the  impression  that  the  means  used  are  helping  him. 
Occasional  abstinence  is  of  use  in  this  direction. 

Patients  that  have  become  impotent  as  a  result  of  severe 
mental  work  must  give  up  their  occupations  for  a  time.  A 
sojourn  in  the  country  should  be  recommended  to  such.  In 
other  cases  they  should  be  advised  to  perform  coitus  in  a  state 
of  partial  intoxication,  in  the  hope  that  the  alcohol  will  effect 
a  partial  paralysis  of  the  mental  activities.  Regulation  of  sexual 
intercourse  also  plays  a  part.  A  suitable  marriage  is  in  all 
cases  an  excellent  preventive  of  impotence. 

Waiting- Suggestion  and  Hypnotic  Treatment. — The  use  of 
the  cerebral  functions  for  the  purpose  of  cure  consists  of  (a) 
psycho-therapeutics  in  the  waking  state,  the  special  value  of 
which  in  impotence  is  shown  in  the  foregoing  paragraphs ;  (ft) 
suggestive  therapeutics.  The  fundamental  principles  and  dif- 
ferences of  these  two  methods  of  treatment  have  been  given  in 
detail  in  Section  I  (Therapeutics),  and  they  are  as  applicable 
here  as  there.  Psycho-therapeutics  takes  account  of  the 
patient's  judgment,  the  co-ordinating  cerebral  activity,  and  sets 
in  motion  his  will,  his  attention,  and  his  judgment.  Sugges- 
tions, on  the  contrary,  have  the  special  tendency  to  cause  the 
idea  imparted  to  be  transformed  into  an  act.  Then,  the  more 
cerebral  activity  is  dissociated,  the  less  is  the  activity  of  the  con- 
trolling inhibitory  apparatus  of  the  brain,  and  thus  the  more 
the  intensity  of  the  ideo-motor,  ideo-sensory,  and  ideo-sensorial 
reflex  activity  is  increased;  that  is,  suggestibility.  Per  se,  it 
is  a  matter  of  no  consequence  whether  sleep  exists  or  not,  even 
though  it  must  be  allowed  that,  in  spite  of  notable  exceptions, 
sleep  in  general  increases  the  receptivity  for  suggestions. 
Waking-suggestion — -that  is,  the  unqualified  acceptance  and 
appropriation  of  an  idea — always  indicates  a  weakening  of  the 
associative  and  contrasting  ideas,  or  extinction  of  intra-cerebral 
reflex  excitability ;  that  is,  strictly  speaking,  it  may  be  defined 
as  hypnosis.  The  increasing  degree  of  faith  presumes  a  diminu- 
tion of  judgment  and  reflection.  The  results  obtained  with 
the  help  of  imagination,  in  cases  of  impotence,  show  the 


FUNCTIONAL   SEXUAL   WEAKNESS.  97 

peculiar  cerebral  pliability  of  hypnosis ;  as  suggestions  in  the 
waking  state,  they  form  the  transition  to  hypnosis.  Therefore, 
our  series  of  cases  of  cures  by  suggestion  in  the  waking  state 
are  placed  by  the  side  of  those  cured  by  hypnosis  as  a  class 
belonging  to  the  latter.  The  psycho-therapeutics  of  the  waking 
state,  as  we  have  seen,  pass  without  definite  limitation  into 
waking-suggestion,  and  the  latter  into  hypnosis  (in  its  narrower 
sense).  The  physiological  basis  of  suggestive  therapeutic  effect 
in  sexual  weakness  is  the  same  as  in  sexual  hyperaesthesia.  In 
the  patients  of  Section  I  there  is  increased  activity  of  the  sexual 
functions ;  in  impotence,  a  diminution.  Our  introductory  re- 
marks in  Chapter  IV  show  that  ideas  have  an  exciting  and  an 
inhibitory  influence  on  the  sexual  mechanism,  especially  on 
that  of  erection.  The  sexual  functions  stand  in  a  dependent 
relation  to  the  cerebral  cortex.  Ideas,  desires,  and  images  of 
sexual  content  cause  sexual  excitement,  weaken  the  influence 
of  the  inhibitory  centre,  and,  through  the  effect  on  the  erection- 
centre,  induce  the  well-known  vasomotor  and  motor  effects 
which  give  rise  to  the  filling  of  the  penis  with  blood. 

From  this  it  will  be  seen  that  the  object  of  the  treatment  is 
to  strengthen  such  ideas  as  induce  sexual  erethism,  and  that  by 
weakening  habitual  associated  and  pathologically  intense  oppos- 
ing ideas  (cause  of  psychical  impotence),  as  well  as  to  increase 
their  peripheral  effect  (influence  on  erection  and  ejaculation). 
As  a  result  of  the  removal,  the  weakening,  the  dissociation  "  of 
the  organically  associated  ideas  maintaining  the  equilibrium," 
the  suggested  idea  becomes  all-powerful.  The  facilitation  of 
the  process  of  transformation  of  an  idea  into  a  feeling  (libido 
sexualis)  and  movement,  thus  brought  about,  is,  of  course,  not 
subject  to  observation. 

However,  in  order  to  overcome  the  mastery  of  the  inhibi- 
tory centres  over  the  sexual  mechanism  that  has  existed  for 
years,  or,  by  means  of  ideational  stimuli,  to  excite  the  weak- 
ened sexual  functions  to  renewed  activity,  a  few  hypnotic  sit- 
tings are  not  sufficient,  as  so  many  patients  believe,  but  the 
unhindered  ideational  stimulus  of  suggestion  must  be  repeated 
until,  through  cumulative  effect,  its  intensity  and  lasting  influ- 


98  SEXUAL    IMPOTENCE    AND    ANESTHESIA. 

ence  seem  assured;  until  it  acts  automatically  from  the  brain. 
An  impotent  patient  who  has  been  able  to  perform  coitus  once, 
as  a  result  of  suggestive  treatment,  can  only  be  regarded  as  con- 
valescent ;  only  repeated  and  habitual  success  in  sexual  congress 
constitutes  a  cure.  Length  of  treatment  and  prognosis  must 
follow  these  principles. 

Eingier1  very  justly  remarks  that  in  no  form  of  medical 
treatment  is  the  tendency  to  break  it  off  so  pronounced  as  in 
hypnotic  treatment.  The  patient  expects  wonders,  and,  as  a 
rule,  is  disappointed.  The  simplicity  of  the  procedure  does 
not  come  up  to  his  expectations.  Besides,  the  first  symp- 
toms of  improvement  often  come  unnoticed  and  unconsciously 
to  the  patient,  in  contrast  with  the  more  marked  effect  of 
physical  and  medicinal  procedures.  Besides,  many  patients  at 
first,  during  hypnotic  treatment,  are  inclined  to  ascribe  the 
more  frequent  occurrence  of  sexual  desire  and  erections  to 
other  causes.  The  causal  relation  of  cure  and  suggestive 
treatment  escapes  the  observation  of  the  patient,  and  often  it  is 
only  the  constant  association  in  time  of  improvement  with  the 
suggestive  treatment  which  causes  an  actual  recognition  of  the 
psycho-therapeutic  effect.  An  occasional  pause  in  treatment, 
as  a  rule,  convinces  such  patients ;  for,  as  soon  as  they  attempt 
to  be  independent,  they  recognize  the  assistance  afforded  them 
by  suggestion. 

On  the  whole,  then,  it  is  best  to  treat  patients  for  chronic 
impotence  with  suggestion  only  when  they  will  engage  not  to 
discontinue  the  treatment  prematurely,  for,  by  so  doing,  they 
increase  their  want  of  confidence  in  themselves,  make  a  repe- 
tition of  the  procedure  more  difficult  by  auto-suggestion,  and 
injure  the  reputation  of  psycho-therapeutics,  sufficiently  at- 
tacked and  misunderstood  without  this.  The  great  principle 
in  the  treatment  of  psychical  or  functional  impotence  is  strict 
individualization  with  both  men  and  women.  The  foregoing 
general  principles  will  suffice ;  details  will  be  found  in  the 
histories  contained  in  the  following  chapter. 

1  Erfolge  des  therapeutischen  Hypnotismus  in  der  Landpraxis.     Lchmann,  Miinchen,  1891. 


CHAPTER  VI. 

CASES  ILLUSTRATING  SUGGESTIVE  TREATMENT  OF 
SOME  FORMS  OF  IMPOTENCE. 

THE  following  eighteen  cases  include  all  instances  known 
to  the  writer  of  suggestive  treatment  of  impotence.  By 
"functional"  impotence  in  the  following  cases  is  meant  a  state 
of  sexual  weakness  without  demonstrable  anatomical  founda- 
tion, in  so  far  as  it  is  not  exclusively  and  demonstrably  of 
psychical  origin. 

RESULTS  IN  PSYCHICAL,  FUNCTIONAL,  RELATIVE,  AND  PARALYTIC 

IMPOTENCE. 

Case  21.  Reported  by  Dr.  Van  Renterghem  (Amsterdam).  Psychical 
Impotence.  Lasting  Cure  by  Means  of  Larvated  Waking-Suggestion. — 
G.  S.,  engineer,  aged  29,  married,  fell  from  a  height  of  five  feet  to  the 
floor.  Without  being  severely  injured,  lie  received  several  painful  con- 
tusions, one  in  the  region  of  the  perineum.  He  was  treated  at  home.  For 
the  first  few  da}rs  he  suffered  wrth  trouble  on  defecation,  which  was  soon 
overcome  by  appropriate  treatment.  Pains  had  disappeared  two  weeks 
after  his  fall,  and  he  only  complained  that  his  genital  functions  were  out 
of  order.  On  April  3,  1891,  his  physician  sent  him  to  me.  Present  con- 
dition :  Strong  constitution.  Apparently  in  robust  health.  No  ante- 
cedents, either  nervous  or  in  the  domain  of  the  vita  sexualis.  He  com- 
plains of  impotence.  Genitals  perfectly  normal.  No  disturbance  of  urina- 
tion. The  man  is  married,  loves  his  wife,  and  has  always  lived  with  her 
in  perfect  harmony  ;  and  he  has  led  a  regular  life,  both  before  and  since 
his  marriage.  He  confesses  that  he  attempted  coitus  two  days  after  the 
accident,  but  that  it  was  not  successful,  owing  to  pain, — a  fact  that  caused 
him  great  anxiety.  A  second  and  third  attempt,  some  time  later,  met 
with  no  better  success.  He  thinks,  therefore,  that,  as  a  result  of  the 
fall,  some  disturbance  of  the  genitals  has  occurred  which  has  caused  the 
impotence.  Patient  is  much  depressed  and  suffers  on  account  of  the 
disturbance  of  his  marital  relations.  I  was  successful  in  quieting  him 
with  the  assurance  that  if  some  hindrance  to  ejaculation  had  resulted, 
it  could  be  removed  by  repeated  introduction  of  a  sound.  At  the  first 
attempt  I  introduced  a  sound  with  ease.  I  allowed  the  instrument  to 
remain  in  the  urethra  one  minute.  Before  the  patient  left  he  promised 
me  not  to  have  congress  with  his  wife  until  I  gave  him  permission. 

(99) 


100  SEXUAL   IMPOTENCE   AND   ANAESTHESIA. 

April  7th.  Though  occupying  a  bed  with  his  wife,  he  did  not  ap- 
proach her  last  night ;  but  erection  occurred  repeatedly.  Introduction 
of  sound. 

April  10th.  He  asks  for  permission  to  attempt  coitus.  I  refuse  it. 
Use  of  sound. 

April  14th.  Patient  does  not  appear. 

April  17th.  Patient  excuses  his  absence  on  the  14th  as  a  result  of 
business.  Introduction  of  sound.  After  this,  he  confesses  that  he  dis- 
regarded my  instructions  and  had  congress  with  his  wife.  Coitus  was 
perfectly  successful.  When  asked  why  he  had  not  told  me  this  before, 
as  it  would  have  made  the  use  of  the  instrument  superfluous,,  he  answered 
that  he  had  postponed  his  confession  purposely,  fearing  that  I  would  be 
unwilling  to  continue  the  treatment,  upon  which  all  his  faith  rested. 

It  is  to  be  noted  that  to  bring  about  a  permanent  cure  I  introduced 
the  sound  but  three  times,  and  that  at  long  intervals. 

Case  22.  Reported  by  Dr.  Van  Renterghem.  Psychical  Impotence 
Treated  without  Success  by  Suggestion  in  One  Sitting. — B.,  civil  engineer, 
aged  28,  was  sent  to  me  July  8, 1889,  by  his  physician,  to  have  his  belief 
in  his  impotence  removed.  The  young  man  (one  month  married)  seemed 
very  nervous,  was  uncommunicative,  and  so  anxious  that  my  efforts  to 
hypnotize  him  were  entirely  unsuccessful.  He  did  not  return. 

Case  23.  Reported  by  Dr.  Van  Renterghem.  Functional  Impotence 
Treated  in  Thirty  Hypnotic  Sittings  without  Success. — J.  K.,  merchant, 
married,  aged  42.  Gonorrhoea.  Growths  in  the  urethra  had  been 
removed  by  galvano-cautery.  He  suffers  with  emphysema  and  chronic 
bronchial  catarrh.  Frequent  (several  times  a  day)  attacks,  which  are 
sometimes  accompanied  by  loss  of  consciousness.  Remissions,  which, 
however,  never  last  more  than  two  or  three  weeks.  Besides,  states  of 
great  anxiety,  disturbed  digestion,  fluid  stools,  etc.  Unhappy  married 
life.  Separate  sleeping-apartments.  While  abroad  he  was  treated  for 
a  long  time  for  psychical  impotence.  His  present  physician  (specalist 
in  genito-urinary  diseases)  states  that  the  impotence  does  not  depend 
upon  any  demonstrable  anatomical  causes.  K.  sleeps  well. 

June  7,  1888.  Pollution  occurs  from  time  to  time,  always  preceded 
by  complete  erection.  Still,  K.  does  not  venture  to  approach  his  wife 
sexually.  He  asks  me  to  hypnotize  him  and  suggest  forcibly  that  he 
perform  coitus.  He  thinks  he  cannot  be  hypnotized,  because  Donato 
was  not  successful  in  fascinating  him. 

Hypnotic  sittings  were  had  between  June  18th  and  July  12th. 
However,  he  never  passed  into  hypnosis  deeper  than  the  third  degree  of 
Bernheim's  classification  (ninth  degree),  and  was  little  susceptible.  The 
result  was  negative.  The  patient  promised  to  inform  me  of  any  subse- 
quent success. 


TREATMENT    OF    PSYCHICAL   IMPOTENCE.  101 

Case  24.  Reported  by  Dr.  Van  Renterghem.  Relative  Impotence 
Cured  by  Hypnotic  Suggestion. — J.  K.,  bridge  engineer,  aged  44;  mar- 
ried at  26.  He  lost  his  wile  after  nine  years  of  married  life.  Since  this 
time  he  had  had  intimate  intercourse  with  a  single  woman.  Four  months 
ago  these  relations  were  interrupted  by  a  project  of  marriage.  Since 
this  time  he  had  had,  possibly  from  disinclination,  only  irregular  inter- 
course. On  the  very  first  attempt  coitus  was  incomplete,  and  did  not 
give  him  the  accustomed  pleasure  ;  and  he  thought  himself  subject  to 
premature  impotence.  At  second  time  erection  occurred,  but  not  ejacu- 
lation;  a  third  time  there  was  not  even  erection.  This  impotence  was 
accompanied  by  an  indescribable  feeling  of  illness,  and  was  followed  by 
a  host  of  nervous  symptoms, — anxiety,  sleeplessness,  pain  in  the  region 
of  the  kidnej's,  excitability,  etc. 

May  19,  1888,  I  began  to  treat  K.  He  came  to  me  in  a  state  of 
great  excitement.  I  was  successful  in  quieting  him  in  hypnosis.  1  sug- 
gested to  him  "disappearance  of  the  nervous  symptoms,"  and  the  assur- 
ance that  his  impotence  had  no  tangible  cause,  but  depended  entirely 
upon  his  mental  excitement. 

May  20th.  Patient  has  become  much  quieter  since  yesterday.  He 
had  a  good  night,  and  awoke  without  the  feeling  of  anxiety.  Before 
going  to  sleep  he  had  a  complete  erection,  and  also  on  awaking.  Repe- 
tition of  the  suggestions  of  j^esterday. 

May  21st.  More  excited  than  yesterday.  Some  sleep  last  night,  but 
not  quiet.  Pain  in  back  and  languor.  I  hypnotized  him  and  induced 
catalepsy.  Suggestibility  increases.  After  waking  he  states  that  he 
has  felt  the  sensations  of  sleep.  I  suggested  to  him  to  find  his  former 
mistress  and  perform  the  sexual  act  with  her,  assuring  him  that  he 
would  succeed  in  it. 

May  23d.  K.  excuses  himself  for  having  missed  the  sitting  yester- 
day by  attributing  his  absence  to  business.  He  had  followed  my  advice, 
and  coitus  took  place  to  his  entire  satisfaction.  I  hypnotize  him  again, 
and  suggest  that  he  perform  coitus  this  evening  with  another  woman, 
giving  assurance  that  it  would  be  successful. 

May  24th.  Yesterday's  attempt  was  perfectly  satisfactor}\  Some 
months  later  I  received  notice  of  his  marriage. 

Case  25.  Reported  by  Dr.  Li'ebeault.  Psychical  Impotence  Improved 
by  Hypnotic  Suggestion. — B.,  aged  20  years,  healthy,  has  powerful  erec- 
tions when  he  thinks  of  the  woman  he  loves,  but  as  soon  as  he  is  in  her 
arms  he  grows  so  excited  that  erection  is  no  longer  possible. 

On  the  first  attempt  at  hypnosis  B.  passes  into  light  sleep,  and,  in 
five  sittings,  is  so  influenced  that  he  is  able  to  perform  coitus  for  some 
time.  Later  he  relapsed  ;  but  he  had  to  leave  Nancy,  and  treatment 
could  not  be  continued. 

Case  26.  Reported  by  Dr.  Liebeault.    Impotence  Caused  by  Auditory 


102  SEXUAL   IMPOTENCE   AND    ANESTHESIA. 

Hallucinations  Cured  by  Suggestion. — L.,  aged  50  years,  with  other  im- 
perative ideas,  has  suddenly  developed  the  notion  that  he  can  no  longer 
fulfill  his  marital  duties.  He  hears  voices  that  keep  him  from  it.  I 
succeeded  in  removing  his  hallucinations  by  means  of  suggestion.  There- 
after the  patient  was  capable  of  intercourse  with  his  wife  to  his  entire 
satisfaction. 

Case  27.  Reported  by  Professor  Bernheim.  Psychical  Impotence 
Treated  by  Suggestion  without  Success. — For  seven  weeks  I  treated  with 
hypnotic  suggestion  (second  degree)  a  young  man  aged  26  years.  He 
was  hypochondriacal,  sad,  and  preoccupied  with  self.  He  complained, 
also,  of  sexual  impotence,  though  there  had  still  been  erections  for  two 
or  three  years.  Complete  failure. 

Case  28.  Reported  by  Professor  Bernheim.  Psychical  Impotence 
Cured  by  Suggestion. — Male,  aged  25  years ;  neurasthenic  ;  has  thoughts 
of  suicide.  For  about  two  years  he  has  suffered  with  impotence.  His 
mother  is  nervous.  On  the  first  attempt  at  hypnosis  he  passed  into 
deep  sleep.  He  was  completely  cured  in  ten  days  by  suggestion. 

Case  29.  Reported  by  .Professor  Bernheim.  Relative  Impotence. 
Probable  Success  by  Means  of  Hypnotic  Treatment. — A  Belgian  mer- 
chant consulted  me  three  years  ago  on  the  following  subject :  Married 
three  years  and  loving  his  wife,  he  has  never  been  able  to  satisfy  her. 
Erection  incomplete  in  spite  of  all  efforts.  Still,  he  is  not  impotent; 
for,  when  he  makes  the  attempt  with  another  woman,  he  can  perform 
coitus  three  times  in  a  night.  Patient  is  38  3'ears  of  age,  in  good  health, 
and  without  nervous  antecedents.  Probably  the  emotional  excitement 
on  the  marriage-night,  on  the  first  attempt,  paralyzed  erection,  and  un- 
conscious auto-suggestion,  on  each  new  attempt,  reproduces,  to  a  certain 
extent,  as  a  reflex  act,  the  paralysis  of  the  genito-spinal  centre.  I  hyp- 
notized the  patient  easily.  Deep  sleep,  with  partial  post-hypnotic  amne- 
sia. He  could  remain  in  Nancy  but  three  days.  I  gave  him  six  hypnotic 
sittings,  and  made  him  promise,  in  case  of  failure  with  his  wife,  that  he 
would  return,  that  an  attempt  might  be  made  again  under  the  direct 
influence  of  new  suggestive  treatment.  The  patient  departed,  and  no 
word  was  received  from  him.  He  was  probably  cured  (von  Schrenk). 

Case  30.  Reported  by  Professor  Bernheim.  Psychical  Impotence 
Cured  by  Suggestion. — X.,  laborer,  of  Nancy,  in  November,  1890,  seeks 
my  aid  on  account  of  impotence.  He  had  never  been  able  to  perform 
coitus.  Erections,  especially  at  night;  great  desire  to  perform  coitus. 
He  wishes  to  marry;  but  every  time  he  visits  a  woman  erection  fails  to 
occur.  He  is  tall,  aged  26  years,  of  good  constitution,  very  nervous 
and  impressionable.  He  often  suffers  with  sleeplessness.  His  mother, 
also,  is  said  to  be  nervous.  He  states  that  he  has  never  been  ill  and 
has  never  masturbated.  His  genitals  are  well  formed. 


TREATMENT   OF   PSYCHICAL   IMPOTENCE.  103 

I  hypnotized  him.  He  passed  easily  into  the  second  stage  (cata- 
lepsy, automatism,  memory  after  waking).  Later  he  passed  into  som- 
nambulism several  times  without  memory  on  awaking.  I  hypnotized 
him  daily  for  fifteen  days.  Sleep  at  night  returned.  Nervous  excit- 
ability diminished,  but  impotence  continued  in  spite  of  all  efforts.  I 
continued  the  treatment  once  or  twice  a  week  for  two  or  three  months. 
In  March,  when  I  recognized  that  in  this  way  I  should  obtain  no  imme- 
diate result,  I  sought  to  strengthen  the  idea  in  him  that  he  was  perfectly 
cured,  but  that  he  must  not  make  further  attempt  at  coitus.  "  One  fine 
day,  without  your  thinking  about  it,  this  thing  will  take  place  of  itself." 
I  had  him  visit  me  every  ten  or  fifteen  days,  and  each  time  I  suggested 
to  him  that  the  cure  would  take  place  without  his  thinking  about  it.  In 
July,  1891,  he  informed  me  that  he  had  been  successful.  While  sleeping 
with  a  woman  he  had  no  erections  during  the  night,  but  in  the  morning 
he  was  able  to  perform  coitus  twice.  I  enjoined  him  not  to  abuse  his 
powers  and  to  wait  patiently  for  complete  cure.  Six  months  later  he 
learned  to  accommodate  himself  to  his  erections,  and  he  no  longer  felt 
powerless  in  the  presence  of  a  woman. 

Case  31.  Reported  by  Professor  Bernheim.1  Psychical  Impotence 
Cured  by  Hypnotic  Suggestion. — X.,  merchant,  aged  27,  consulted  me 
October  10, 1889.  He  came  from  the  Urals,  and  was  several  weeks  on  the 
way  before  he  found  me.  He  complained  of  absolute  impotence  and  had 
never  been  able  to  perform  coitus.  At  the  same  time  erections  are 
powerful,  but  in  the  presence  of  a  woman  he  begins  to  tremble  with  ex- 
citement and  erection  disappears.  It  is  apparently  a  case  of  psychical 
impotence  ;  mental  excitement  has  an  inhibitor}'  effect.  Besides,  he 
tells  me  that  he  has  masturb.ited  a  few  times,  but  rather  unconsciously, 
at  night  in  sleep.  Sometimes  this  would  occur  three  nights  in  succession, 
then  it  would  not  occur  again  perhaps  for  ten  or  fifteen  days  or  more. 
X.  seems  very  nervous.  He  is  very  impressionable ;  he  speaks  often 
suddenly  and  easily  begins  to  tremble.  In  his  excitement  he  shoots 
beyond  the  mark.  His  constitution  is  excellent.  He  has  never  been  ill, 
and  has  alwa3rs  been  free  from  nervous  disease.  Examination  negative. 

I  easily  succeeded  in  placing  him  in  deep  sleep.  I  suggested  pli3'S- 
ical  and  mental  rest.  "  There  will  be  no  inclination  to  masturbate  at 
night;  in  the  presence  of  a  woman  erection  will  last  until  the  completion 
of  the  act,  without  the  occurrence  of  excitement.  You  will  be  cool, 
have  no  trace  of  fear,  and  be  able  to  perform  the  act."  The  patient  was 
able  to  remain  in  Nancy  only  from  October  10th  to  23d,  when  his  vaca- 
tion expired.  I  repeated  the  same  suggestions  daily.  After  the  first 
sitting  he  masturbated  no  more  at  night.  Once,  on  the  night  of  October 
13th,  he  awoke  with  his  hand  on  his  penis  and  was  about  to  masturbate  ; 
he  immediately  stopped,  and  the  act  has  not  been  repeated. 

1  Hypnotism,  Suggestion,  etc.,  Paris,  1891,  p.  336. 


104  SEXUAL   IMPOTENCE   AND    ANAESTHESIA. 

October  20th,  fit  suggestion,  lie  attempted  coitus,  when  he  noticed 
that  fear  and  tremor  did  not  come  as  formerly.  Therefore  he  thought 
his  object  nearly  attained.  I  suggested  to  him  now  energetically  repe- 
tition of  the  attempt  on  October  22d,  with  the  assurance  that  he  would 
have  complete  success  this  time.  October  23d  he  told  me  of  his  success, 
the  first  of  the  kind  in  his  life.  Though  erection  diminished  toward  the 
end  of  the  act,  yet  he  was  still  able  to  complete  ejaculation.  Now  I 
suggested  that,  once  freed  from  his  excitement,  in  the  future  he  would 
make  no  failures.  He  returned  home  satisfied. 

Case  32.  Reported  by  Dr.  Moll*  Berlin.  Functional  Impotence 
Cured  by  Hypnotic  Suggestion. — J.,  aged  31,  noticed  nine  months  ago 
that  in  coitus  he  had  ejaculation  either  before  immissio  penis  in  vaginam, 
or  that  when  it  took  place  at  the  proper  time  ejaculation  was  devoid  of 
pleasurable  feeling.  After  about  forty  trials  I  was  successful  in  hyp- 
notizing the  patient  so  deeply  that  with  eyes  closed  he  was  obnoxious 
to  the  most  various  suggested  hallucinations.  After  this,  the  attempt, 
repeated  for  several  days,  to  induce  him  to  perform  coitus  by  post- 
hypnotic  suggestion,  was  so  successful  that  within  four  days  the  patient 
was  able  to  perform  coitus  twice  with  immissio  penis  and  normal  lustful 
feeling.  Unfortunately,  I  lost  sight  of  the  patient,  who  showed  no 
objective  signs  of  disturbance  of  the  sexual  organs  or  nervous  system  ; 
for  in  the  second  coitus  he  acquired  gonorrhoea  after  having  dispensed 
with  preventive  measures,  against  my  advice. 

Case  33.  Personal  Observation.  Functional  Sexual  Weakness 
Treated  in  One  Sitting  by  Suggestion  without  Success. — T.,  aged  31. 
Father  nervous.  Had  measles  ischias  lasting  two  or  three  years,  but 
no  other  diseases.  Masturbated  since  his  twentieth  year.  After  self- 
abuse  continued  five  years,  first  attempt  at  coitus ;  ejaculatio  prsecox 
with  incomplete  erection.  States  that  he  has  not  masturbated  for  a 
year ;  often  awakes  in  the  morning  with  complete  erection.  Pollutions 
at  night  once  or  twice  a  week.  Moderate  hypereesthesia  of  the  glans. 
Neurasthenic  complaints;  easily  tired;  tinnitus  aurium.  Great  weari- 
ness on  awaking  in  the  morning;  rising  requires  great  resolution. 
Cardiac  palpitation.  Depression,  with  entire  loss  of  self-confidence. 
Patient  was  never  in  love.  Genitals  normally  developed.  Water,  elec- 
tricity, and  sounds  have  been  used  for  his  psychical  impotence  in  vain. 
Patient  was  sent  to  me  by  Dr.  Kopp.  January  12,  1891,  first  attempt 
at  hypnosis.  T.  has  an  idiosyncrasy  against  hypnosis.  He  cannot  make 
himself  passive;  consequently,  allows  his  attention  to  be  diverted,  and 
conceals  his  apparent  anxiety  and  excitement  by  effectual  resistance. 
On  January  13th  the  patient  writes  me  that  it  is  impossible  for  him  to 
overcome  his  idiosyncrasy,  and  therefore  will  not  take  any  further 
treatment. 

1  Reported  by  Caspar,  Impotentta  et  eterilitas  virilis,  Miinchen,  1890,  p.  99. 


TREATMENT    OF    PSYCHICAL    IMPOTENCE.  105 

Of  course,  the  negative  result  of  a  single  trial  is  of  no 
value  in  answering  the  question  whether  and  in  what  length 
of  time  psychical  impotence  can  be  cured  by  suggestion.  In 
spite  of  the  prejudice  of  the  patient  in  the  foregoing  case,  the 
prognosis  with  psychical  treatment  did  not  seem  to  me  at  all 
unfavorable.  A  series  of  sittings  would  have  taught  the  pa- 
tient to  submit  to  the  influence,  and  thus  his  suggestibility 
would  have  proportionately  increased.  The  gradual  occurrence 
of  quiet  by  means  of  suggestion,  and  the  removal  of  neuras- 
thenic symptoms  in  connection  with  careful  attempts  at  coitus, 
in  my  opinion  would  have  brought  about  a  cure  in  spite  of  the 
difficulties. 

Case  34.  Personal  Observation.  Impotentia  Paralytica  (?)  Treated 
Experimentally  in  Four  Sittings.  Temporary  Improvement. — Male, 
aged  41.  Mother  died  of  heart  disease.  Father  and  brothers  and  sisters 
living  and  healthy.  B.  has  "never  had  other  illness  than  the  diseases  of 
childhood  and  emphysema  that  causes  little  trouble.  From  his  tenth  to 
his  sixteenth  year  he  practiced  onanism  excessively.  As  a  result,  irrita- 
ble weakness  of  the  lumbar  cord  came  on.  Frequent  pollutions  in  climb- 
ing, riding,  and  in  sleep.  B.'s  hyperexcitability  is  so  much  developed 
that  when  he  merely  thinks  of  a  woman  ejaculation  results  with  a  relaxed 
or  half-erect  organ.  In  attempts  at  coitus,  ejaculatio  ante  introitum  va- 
ginae; immissio  has  never  been  accomplished,  though  in  previous  years, 
especially  nights  and  mornings,  erections  were  not  infrequent.  The  pa- 
tient can  only  recall  having  had  one  actual  erection  in  the  last  two  years. 
Nevertheless,  in  the  last  four  years  he  had  attempted  coitus  four  times, 
always  with  great  psychical  excitement.  There  is  pain  in  the  back  after 
pollutions,  which  still  occur  frequently.  Besides  great  depression  there 
are  no  other  abnormal  nervous  symptoms.  Genitals  normally  developed. 

The  patient  has  tried  in  vain  all  kinds  of  treatment  at  the  hands  of 
celebrated  specialists, — hygienic,  electrical,  medical,  hydropathic, — and 
now,  as  a  last  resort,  wishes  to  try  suggestion,  thinking  that  his  impo- 
tence may  be  of  psychical  origin;  that,  if  his  excitement  on  attempting 
coitus  can  be  overcome,  perhaps  he  will  succeed.  In  spite  of  an 
unfavorable  prognosis,  in  order  not  to  destroy  all  the  patient's  hope,  I 
made  four  hypnotic  attempts  from  September  16  to  19,  1889.  In  these 
sittings  the  patient  did  not  pass  beyond  slight  somnolence.  On  the 
night  of  September  16th  and  17th  lie  noticed  the  beginning  of  erection, 
which  increased  the  next  night.  Attempt  at  coitus  September  18th. 
Weak  erection  made  immissio  penis  in  vaginam  possible,  but  only  for  a 
short  distance.  But  ejaculation  took  place  in  the  vagina.  On  Septem- 


106  SEXUAL    IMPOTENCE   AND    ANAESTHESIA. 

ber  19th  the  patient  was  called  away  from  Munich,  and  could  only  be 
discharged  as  essentially  improved.  In  spite  of  the  unfavorable  con- 
ditions, owing  to  the  slight  improvement,  continuance  of  treatment  would 
have  been  advisable. 

Case  35.  Personal  Observation.  Psychical  Impotence  Essentially 
Improved  in  Three  Hypnotic  Sittings.  Favorable  Prognosis. — K.,  aged 
29.  No  hereditary  taint.  Parents  and  brothers  and  sisters  healthy.  Dis- 
eases of  childhood, — scarlet  fever,  dropsy,  scabies,  till  his  twelfth  3'ear. 
He  began  masturbation  in  his  fourteenth  year,  taught  by  a  companion, 
and  he  practiced  it  daily  until  his  twenty-first  year,  always  fancj'ing  him- 
self in  the  sexual  act  with  women.  Onanism  less  frequent  since  his  twen- 
tieth year,  and  abandonment  of  the  habit  since  his  twenty-fourth  year. 
The  patient  has  never  noticed  any  injurious  effect  from  the  vice  on  his 
physical  or  mental  health.  Physically  he  seems  entirely  healthy.  Pollu- 
tions every  three  or  four  weeks.  Nights  and  mornings  erections  are  fre- 
quent, and  the}'  also  occur  during  the  day  at  thought  of  a  woman.  In  spite 
of  numerous  attempts,  the  patient  has  not  been  able  (in  ten  years)  to  per- 
form immissio  penis  and  complete  coitus.  Ejaculatio  prsecox  and  relaxa- 
tion of  the  organ  before  introduction  have  made  all  attempts  futile.  His 
libido  sexualis  is  very  intense ;  he  loves  a  girl  and  wishes  to  marry,  but 
the  thought  of  failure  has  become  an  imperative  idea.  At  each  new  trial 
there  is  such  intense  psychical  excitement  that  he  breaks  out  in  a  per- 
spiration. The  patient  came  to  consult  me  September  26th,  and,  though 
desiring  help,  he  was  so  much  under  the  influence  of  auto-suggestion 
that  he  could  not  be  h}rpnotized.  First  trial,  September  26th.  Yery 
slight  somnolence.  He  denies  the  influence  and  wants  to  be  put  in  a 
deeper  sleep.  On  this  occasion  quiet  and  success  in  coitus  were  sug- 
gested. On  the  same  day  he  sought  a  puella,  but  immediately  lost  his 
libido  when  he  saw  her  padded  breasts  while  undressing.  The  first  trial 
was  a  failure,  because  no  erection  occurred  in  spite  of  tactile  stimulus. 

After  a  time,  second  trial.  For  the  first  time  in  his  life  the  patient 
succeeds  in  bringing  about  immissio  penis,  but  ejaculation  took  place 
with  a  relaxed  organ  immediately  after  its  introduction  ;  so  that  there 
was  no  gratification,  though  the  emission  took  place  in  the  vagina. 
Nevertheless,  this  is  to  be  regarded  as  some  progress. 

September  27th  the  hypnotic  procedures  had  a  negative  result,  as 
did  another  attempt  at  coitus.  At  the  door  of  a  brothel  the  patient  is 
overcome  with  fear  and  repugnance,  and  turns  away. 

October  4th,  third  hypnotic  trial  with  the  help  of  chloroform  to 
overcome  the  unconscious  but  obstinate  resistance.  K.  passes  into  the 
stage  of  excitement,  which,  by  suggestion,  I  transform  into  hypnosis. 
Suggestive  cataleptic  symptoms.  Energetic  suggestion  that  coitus  will 
be  successful.  On  awaking  the  patient  declares  that  he  has  not  been 
influenced  in  the  least,  but  he  has  but  a  partial  memory  of  it.  He  is 


TREATMENT   OF   PSYCHICAL    IMPOTENCE.  107 

still  possessed  by  tbe  imperative  idea  that  lie  cannot  be  hypnotized.  An 
attempt  at  coitus  on  the  same  day  was  a  fiasco.  Since  the  patient  can 
come  only  once  a  week,  owing  to  his  living  out  of  the  city,  therefore  he 
proposes  to  take  a  vacation  for  several  weeks,  that  suggestions  may  be 
repeated  daily  and  thus  have  a  more  powerful  effect  on  his  condition. 
In  spite  of  the  three  first  trials,  the  patient  is  but  little  improved.  Con- 
sidering his  general  condition,  age,  etc.,  the  prognosis  seems  favorable. 
Before  his  departure  I  assure  the  patient  that  with  a  regular  continuance 
of  his  efforts  certainly  coitus  will  gradually  become  successful ;  that  he 
must  not  allow  himself  to  be  discouraged  by  failure. 

November  15,  1891,  the  patient  writes :  "  Unfortunately-,  I  have  not 
yet  had  any  completely  satisfactory  results,  though  I  must  confess  that 
since  my  first  visit  to  you  I  have  made  some  progress.  I  regularly  have 
half  an  immission  and  can  make  five  or  six  movements,  but  emission  takes 
place  after  three  or  four.  It  is  my  intention  to  continue  my  efforts  this 
winter  by  myself,  and  then  next  year  to  take  your  treatment.  I  think 
then  to  have  success  in  a  week." 

January  30, 1892,  the  patient  writes:  "After  many  attempts  with 
this  single  person,  I  was  so  far  successful  that,  with  proper  approach,  I 
was  able  to  perform  the  act  fully.  However,  whether  I  could  perform 
coitus  with  others  at  any  time  seems  doubtful  to  me.  As  soon  as  I  can 
subject  myself  to  further  suggestive  treatment  at  your  hands,  I  think  I 
shall  be  completely  cured." 

In  this  case  absolute  impotence  has  become  relative.  The 
improvement  of  November,  which  in  the  table  is  given  as  slight 
improvement,  has  become  a  relative  cure,  due  to  suggestive 
treatment. 

Case  36.  Personal  Observation.  Relative  Impotentia  Cceundi  Psy- 
chica  with  Neurasthenic  Symptoms.  Suggestive  Treatment.  Negative  He- 
suit  with  Reference  to  Sexual  Weakness ;  Positive  with  Reference  to  the 
Nervous  Symptoms. — X.,  aged  36,  landed  proprietor,  married,  childless. 
Parents,  especially  father,  nervous.  In  youth,  masturbation.  Patient 
very  much  "  spoiled  "  in  rearing ;  anxious  about  his  health  to  the  extent  of 
silliness.  Constantly  in  fear  of  apoplexy  because  of  congestive  symptoms 
due  to  rich  food.  Strongly  built,  large,  abundant  adipose.  Internal 
organs,  lungs,  heart,  without  demonstrable  disturbance;  sometimes 
nervous,  disagreeable  cardiac  palpitation.  Abdominal  organs  normal.. 
Penis  and  testicles  somewhat  small,  but,  according  to  statement  of  phy- 
sician, functionally  capable.  Trials  have  proved  this.  Sleep  and  appe- 
tite, with  few  exceptions,  excellent.  In  short,  the  patient  may  be  called 
a  healthy  man  physically  ;  on  the  other  hand,  his  great  anxiet}7  is  a 
mental  abnormality,  causing  changing  hypochondriacal  moods  with  rela- 


108  SEXUAL    IMPOTENCE   AND    ANAESTHESIA. 

tive  impotence.  Energetic  advice  and  dietetic  rules  have,  thus  far, 
always  had  a  good  influence,  but  have  been  insufficient  to  bring  about 
cure.  Aphrodisiacs  (mild)  proved  worthless.  This  from  his  physician, 
who  sent  him  to  me  October  It,  1889. 

The  patient  was  remarkably  anxious  and  very  reticent  in  his  com- 
munications. Therefore,  on  the  first  day  it  was  not  possible  for  me  to 
learn  the  details  and  causes  of  his  psychical  impotence.  The  first  sit- 
ting, therefore,  could  be  regarded  only  as  a  test  whether  the  patient  was 
susceptible  to  suggestions  or  not. 

With  the  use  of  the  method  of  Bernheim  and  Lie'beault,  the  patient 
passed  into  somnambulism.  Complete  hypotaxis,  suggestive  catalepsy, 
and  post-hypnotic  amnesia.  Decrease  of  nervous  excitability  and 
anxiety  and  disappearance  of  palpitation  suggested.  Success  in  coitus 
in  the  future.  The  patient  left  the  same  day.  The  effect  on  his  general 
condition  was  favorable.  According  to  the  statement  of  his  physician, 
the  patient  was  much  improved  by  the  sittings  held  during  the  next 
week;  was  less  excited,  and  made  no  complaint.  Still,  his  impotence 
remained  unchanged,  as  I  had  foreseen.  The  patient  could  not  follow 
my  advice  to  submit  himself  to  treatment  for  several  weeks  for  his 
impotence. 

On  the  occasion  of  a  visit  to  his  home,  October  27th  and  28th,  I 
hypnotized  the  patient  twice,  with  the  same  success  as  on  the  17th. 
Again,  according  to  the  physician's  statement,  the  suggestions  quieted 
him  and  improved  his  condition,  without  having  any  special  influence  on 
his  sexual  sphere.  In  a  letter  of  December  7,  1890,  the  physician 
reports  his  condition  as  "  very  satisfactory." 

The  foregoing  case,  on  its  negative  side,  is  not  especially 
instructive.  As  I  learned  in  the  course  of  treatment,  the  patient 
was  able  to  have  congress  with  other  women,  but  not  with  his 
wife.  His  wife  seemed  to  be  a  natura  frigida ;  at  any  rate,  she 
does  not  know  how  to  respond  to  her  husband.  In  such  a  deli- 
cate case,  as  long  as  there  is  no  sympathetic  assistance  on  the 
part  of  the  wife,  the  treatment  of  the  husband  alone  must  remain 
fruitless. 

In  such  cases  it  is  always  the  part  of  the  physician  to 
prepare  the  wife  mentally,  eventually  by  means  of  hypnotic 
suggestion  ;  that  is,  to  remove  any  possible  indifference  or  want 
of  proper  interest  constituting  a  mental  impediment.  I  am 
convinced  that  in  the  foregoing  case  the  married  life  could  be 
made  happier  if  both  parties  could  be  subjected  to  systematic 
treatment. 


TREATMENT   OF   PSYCHICAL   IMPOTENCE.  109 

Case  37.  Personal  Observation.  Impotentia  Coeundi  Psychica  on  a 
Neurasthenic  Basis  Cured  by  Suggestion. — A.  B.,  aged  33,  physician, 
without  hereditary  taint.  The  patient  has  had  no  severe  diseases  aside 
from  typhus  in  his  youth.  Sexual  desire  appeared  in  his  tenth  year. 
From  this  time,  onauism  without  noticeable  effect  on  the  nervous  sys- 
tem. Abandonment  of  the  habit  with  the  beginning  of  hetero-sexual 
intercourse.  Congress  was  successful  without  especial  difficulty  till  his 
thirtieth  year.  Patient  is  without  libido  nimia,  moderate  on  the  whole. 
Gonorrhoea,  which  lasted  a  long  time,  made  coitus  impossible  for  a  long 
period.  After  recovery,  hyperaesthesia  of  the  glans  remained,  with  irri- 
table weakness  of  the  sphincter  vesicse.  On  attempting  coitus,  violent 
mental  excitement,  with  feeling  of  anxiety;  erection  impossible.  Impo- 
tentia coeundi.  The  patient  was  treated  for  a  long  time  by  noted  special- 
ists with  cold  sounds,  electricity,  etc.,  without  noticeable  success. 

B.  is  about  to  become  engaged,  and  is  unhappy  over  his  condition, 
which  constantly  takes  up  all  his  thoughts.  His  sleep  is  undisturbed, 
though  he  has  erections  and  pollutions.  At  Professor  Forel's  advice,  he 
seeks  help  from  me  by  means  of  hypnotic  treatment. 

October  29,  1889,  first  attempt.  Complete  hypotaxis,  suggestive 
catalepsy,  and  impossibility  to  voluntarily  overcome  contractures.  Pa- 
tient quieted  by  suggestion  ;  prospect  of  complete  virility  given  with 
diminution  of  the  troublesome  sensations.  No  post-l^-pnotic  amnesia. 
On  the  same  day  coitus  is  twice  performed  with  a  prostitute  without  the 
former  excitement. 

October  30th.  The  hyperaesthesia,  which  compels  the  patient  to 
think  constantly  of  his  trouble,  is  unchanged.  Second  hypnosis ;  sug- 
gestions the  same  as  on  the  29th.  Sexual  congress  again  to-day ;  com- 
plete erection,  but  ejaculation  premature. 

October  31st.  Hyperaesthesia  unchanged.  On  this  day  and  on  No- 
vember 1st  removal  of  his  attention  from  his  own  person  energetically 
commanded  ;  other  suggestions  the  same.  The  patient  thinks  less  about 
his  condition  ;  weakness  of  the  sphincter  of  the  bladder  does  not  cause 
any  more  complaint;  simultaneous  diminution  of  the  hyperaesthesia, 
though  it  is  still  present.  Business  calls  the  patient  away  before  conclu- 
sion of  treatment.  He  wrote  me  December  3,  1889,  that  "  shortly  before 
taking  the  train  I  performed  coitus  perfectly,"  but,  unfortunately,  he  con- 
tracted gonorrhoea,  which  prevented  further  efforts.  At  the  conclusion 
of  his  letter  the  patient  expresses  a  desire  to  return  to  Munich,  as  soon 
as  circumstances  allow,  to  perfect  the  success  alread}'  obtained.  When 
I  met  him,  about  a  year  later,  the  patient  informed  me  that  he  required 
no  further  treatment  after  his  recovery  from  the  gonorrhoea.  Power 
continued  permanent,  and  the  troublesome  symptoms  gradually  disap- 
peared. 


110  SEXUAL   IMPOTENCE   AND    ANAESTHESIA. 

In  the  foregoing  case,  in  four  hypnotic  sittings,  all  that 
was  possible  was  attained ;  that  is,  by  removing  the  psychical 
inhibition  the  patient  was  lastingly  convinced  of  his  sexual 
power,  which  exercised  a  favorable  influence  on  the  hyper- 
aBsthesia,  also  probably  due  to  psychical  causes. 

The  patient  owes  his  cure  to  suggestion.  It  was  perma- 
nent. Exactly  two  years  later,  in  October,  1891,  the  patient 
relapsed  as  a  result  of  severe  nervous  disease. 

Case  38.  Personal  Observation.  Impotentia  Cceundi  Psychica  et  Ner- 
vosa  Irritativa  (Atonica?)  of  Twelve  Years1  Duration  Cured  in  Two 
Months  by  Suggestive  Treatment. — S.,  aged  34.  Mother  died  of  dropsy, 
father  of  tuberculosis.  One  sister  healthy,  a  second  has  diseased  eyes. 
Maternal  uncle  and  his  son  epileptic.  S.  was  healthy  as  a  child.  At  the 
age  of  15  was  manustuprated  by  a  servant-girl ;  this  led  him  to  mutual 
onanism,  without,  however,  allowing  the  boy  to  perform  immissio  penis. 
"  I  stood,"  as  he  said,  "at  the  well  without  being  able  to  dip  from  it." 
This  intense  excitation  of  his  libido  sexualis  led  him  to  auto-mastur- 
bation, which  for  the  first  two  or  three  months  he  practiced  two  or  three 
times  a  day ;  later,  several  times  a  week.  At  18  he  practiced  it  but 
once  a  week.  At  that  time  he  reveled  in  lascivious  pictures,  and  in- 
creased his  power  of  fancy  by  looking  at  obscene  photographs  and  arti- 
ficially retarded  ejaculation  in  the  onanistic  act.  As  a  result,  intense 
sexual  hypersesthesia,  infrequently  ejaculation  through  mental  stimulus 
alone  with  intense  lustful  feeling.  At  the  age  of  22  he  gave  up  mastur- 
bation. First  coitus  fairly  successful,  but  without  the  expected  satisfac- 
tion..  He  was  much  occupied  with  erotic  thoughts,  and  from  this  time 
experienced  impotence  growing  more  and  more  pronounced.  He  remem- 
bers to  have  performed  coitus  only  once  with  complete  satisfaction,  and 
that  with  an  attractive  servant-girl.  Defect  and  want  of  erection,  pre- 
mature ejaculation,  sometimes  with  relaxed  organ,  and  diminution  and 
complete  absence  of  pleasurable  feeling  sent  him,  at  the  age  of  23,  to  phy- 
sicians ;  and  he  has  now  been  treated  for  eleven  j^ears  without  any  essen- 
tial change  in  his  condition,  and  that  in  spite  of  a  favorable  prognosis  in 
general.  Hydropathic  and  electrical  treatment  in  all  possible  forms 
fruitless.  In  1889,  gonorrhoea  from  an  attempt  at  coitus,  which  lasted 
till  February,  1890.  Orchitis  due  to  the  use  of  sounds  (?),  but  probably 
the  result  of  the  gonorrhoea.  Previous  to  beginning  treatment  with 
me,  careful  treatment  with  bougies  for  five  months  with  galvanism. 
Gymnastic  exercises,  in  spite  of  prescription,  were  not  carried  out 
sj'stematically  enough. 

Tbe  patient  appears  intelligent,  but  his  memory  has  suffered  much. 
Depressed,  confused  ;  want  of  energy,  incapable  of  determination,  a  cer- 


TREATMENT   OF   PSYCHICA^   IMPOTENCE.  Ill 

tain  apathy.  He  has  no  interest  in  anything.  Phlegmatic  temperament. 
Very  corpulent.  Genitals  fully  developed.  Right  hernia  ;  tendency  to 
it  on  the  left  side.  Penis  short  and  thick  ;  glans  blue  and  remarkably 
insensitive.  Both  testicles  sensitive  to  hard  pressure.  Left  epididymi- 
tis  ;  cord  harder  than  usual  on  palpation.  Spermatozoa  are  present,  but 
with  diminished  vitality.  It  is  also  demonstrated  microscopically  that 
there  is  no  remnant  of  gonorrhoea.  Patient  has  occasional  pollutions 
(about  once  a  month),  especialty  frequent  nights  and  mornings,  some- 
times during  the  day,  with  powerful  erections.  His  libido  sexualis  is 
very  lively,  but  in  attempts  at  coitus  inhibitory  ideas  and  feelings  of 
anxiety  (fear  of  infection,  of  impotence)  are  so  dominant  that  erections 
do  not  occur,  and  his  libido  is  changed  to  an  irresistible  disinclination 
for  the  act.  The  merest  trifle — want  of  neatness  in  the  puella,  etc. — 
may  call  the  inhibitory  mechanism  into  action.  Looked  at  from  this 
stand-point,  especially  considering  the  erections  and  the  living  spermato- 
zoa, the  patient,  as  all  physicians  have  declared,  has  impotentia  coeundi 
psychica ;  but  he  also  certainly  exhibits  the  result  of  onanism  (as 
described  above)  in  signs  of  irritable  weakness,  as  well  as  a  diminution 
of  virility  manifest  in  his  character,  which  depends  not  only  on  psj-chi- 
cal  inhibition,  but  is  in  contrast  with  his  intense  libido  sexualis.  The 
want  of  lustful  feeling  and  anaesthesia  of  the  glans  are  due  undoubtedly 
to  the  hj'perexcitation  of  the  reflex  arc  by  onanistic  excesses.  There- 
fore, the  diagnosis  is  impotentia  coeundi  nervosa  irritativa  et  psychica. 

October  1,  1891,  first  hypnotic  attempt.  Somnolence  which,  from 
sitting  to  sitting,  aided  by  darkness  and  a  pleasant  reclining  attitude,  is 
deepened  to  sleep.  Suggestive  cataleps}-.  During  October  daily  hyp- 
notic sittings,  lasting  from  one-half  to  three-fourths  of  an  hour.  Sugges- 
tions :  Self-confidence  in  coitus  ;  assurance  of  success  in  it ;  increasing 
pleasure ;  pleasanter  mood.  Daily  repetitions  of  these  suggestions. 
Frequently,  after  the  end  of  these  sittings,  erections  and  libido  sexualis 
occur.  During  the  night  of  October  14th  the  patient  had  a  pollution, 
with  increased  pleasurable  sensation. 

October  18th,  on  the  way  to  a  brothel,  he  was  seized  with  fear  of 
making  a  fiasco.  He  turned  back ;  depressed.  During  the  first  half 
of  October,  two  visits  to  a  puella  without  the  occurrence  of  erection. 
Forbidden  to  induce  erection  by  tactile  stimulation.  During  October 
the  patient  had  powerful  erections  either  at  night  or  on  waking  in  the 
morning,  sometimes  during  the  day. 

October  27th,  first  attempt  at  coitus.  On  my  advice,  the  patient 
waited  (without  tactile  stimulation)  for  the  spontaneous  occurrence  of 
erection.  After  it  came  on,  perfect  immissio  penis,  but  disappearance  of 
the  erection  during  the  act.  Thereafter  help  at  the  hands  of  the  puella. 
Then  followed  correct  performance  of  the  act,  with  ejaculation  at  the 
proper  time  (neither  premature  nor  retarded),  and  a  feeling  of  satisfac- 


112  SEXUAL   IMPOTENCE   AND    ANESTHESIA. 

tion,  even  though  the  intensity  of  lustful  feeling  was  not  up  to  what  the 
patient  desired.  Post-coitum  and  the  next  day,  a  feeling  of  repugnance 
at  thought  of  sexual  congress,  with  depression.  The  sexual  indifference 
disappeared  in  two  days.  Awakening  of  self-confidence  Icty  suggestive 
stimulation.  Early  in  November  renewal  of  erections.  After  November 
5th,  farad ic  penciling  of  the  glans  to  increase  sensation. 

November  9th,  a  visit  of  two  hours  with  a  puella  without  the  occur- 
rence of  erection.  Depressed  by  the  failure.  The  night  of  November 
12th  the  patient  spent  with  a  puella.  Again  complete  failure.  The 
assurance  that  he  had  not  made  a  proper  choice,  and  daily  treatment 
with  faradic  electricity  and  hypnosis  caused  the  patient  to  make  a 
new  attempt  with  a  prostitute  known  for  her  attractive  qualities. 
During  the  night  of  November  20th,  which  he  spent  with  her;  erection 
occurred  spontaneously.  Complete  immissio  penis.  Continuance  of 
erection.  Friction  was  really  felt,  and  ejaculation  was  not  premature. 
More  lustful  pleasure  than  usual,  but  still  not  intense  enough  to  satisfy 
the  patient.  The  mechanical  part  of  the  act  had  been  perfectly  success- 
ful. The  patient  is  happy ;  self-confidence  increases.  The  next  day 
after  the  act  erection  occurred  twice,  in  complete  contrast  with  the  repug- 
nance for  everything  sexual  which  had  previously  occurred  and  lasted 
several  days  after  such  an  attempt.  Treatment  with  hypnosis  and  elec- 
tricity continued. 

November  24th,  he  comes  and  delightedly  reports  that  he  had  per- 
formed coitus  the  preceding  night  to  his  entire  satisfaction.  Erection 
spontaneous  and  continuous,  without  any  aid ;  immissio  penis  and 
ejaculation  perfectly  normal.  This  time  the  patient  experienced  a  pro- 
nounced lustful  feeling.  Erection  occurred  five  times  on  the  day  follow- 
ing this  attempt.  He  had  experienced  nothing  like  this  in  ten  years. 
Performance  of  coitus  again  on  the  night  of  November  26th,  with  the 
same  success. 

Since  the  patient  has  performed  coitus  perfectly  three  times  in  the 
last  three  weeks  without  depressing  or  weakening  effect,  he  can  be  dis- 
charged as  essentially  cured.  In  other  respects  the  hypnotic  treatment 
has  benefited  him.  He  was  hypnotized  twenty-six  times,  and  electricity 
was  used  twenty  times. 

I  take  the  following  from  notes  of  his  condition  sent  me 
by  the  patient : — 

"The  undersigned,  who  was  under  medical  treatment  for  twelve 
years  for  impotence,  without  having  received  the  slightest  benefit,  began 
suggestive  treatment  September  3Uth.  Suggestion  exerted  a  beneficin.1 
influence  at  once,  for  erections  occurred  normally  and  more  frequently 
than  formerly.  After  a  week  a  pollution  occurred,  which  was  repeated 
in  four  or  five  days,  while  of  late  j^ears  such  an  event  was  extremely 


CONCLUDING   REMARKS.  113 

infrequent.  About  the  end  of  November  it  became  possible  to  perform 
coitus  three  times  in  seven  days.  On  the  second  occasion  lustful 
pleasure  was  perceptibly  greater  than  the  former  minimal  pleasure. 
The  disease  which  for  twelve  years  defied  medical  art  may  be  regarded 
as  cured  by  suggestion." 

Several  months  after  discharge  the  patient  wrote  me  that 
the  power  of  erection  had  only  increased  after  his  departure 
(every  night  three  or  four  erections,  sometimes  five  or  six).  He 
performed  coitus  repeatedly  satisfactorily  in  all  respects;  on 
some  occasions  it  was  not  completely  successful,  for  which  he 
blamed  the  other  party.  Later,  he  contracted  gonorrhoea.  Thus, 
the  power  of  erection  and  to  perform  coitus  remained  perfect  in 
all  essential  points  after  discharge.  The  patient,  therefore,  may 
very  justly  be  regarded  as  cured. 

CONCLUDING   REMARKS. 
As  the  table  (next  page)  shows,  of  18  patients  there  were : — 

,    (with  later  report,  .     .     .  4)  , 

Cured,  ]  a[  10  =   55.56  per  cent. 

'  (without  later  report,  .     .  6) 

Essentially  improved, 1  =      5.56  per  cent. 

Slightly  or  temporarily  improved,   .      2  =    11.11  per  cent. 
Treated  without  success,    ....     5  =   27.77  per  cent. 

18      100.00  per  cent. 

Of  the  18  patients,  6  passed  into  somnambulism,  5  into 
hypotaxis,  and  3  into  somnolence ;  in  2  cases  hypnosis  could 
not  be  induced.  One  patient  was  treated  in  the  waking  state. 
In  another  case  the  degree  of  hypnosis  was  not  given.  No  case 
in  a  female  was  treated.  The  number  of  sittings  varied  from 
one  to  fifty-six.  Ten  patients  were  cured.  According  to  the 
foregoing  figures,  the  prospect  of  success  in  the  treatment  of 
functional  or  psychical  impotence  by  hypnotic  suggestion  is 
60  per  cent.  At  the  same  time,  it  should  be  remembered  that 
in  some  cases  systematic  treatment  could  not  be  carried  out ; 
and  that  other  cases,  owing  to  the  want  of  success  by  other 
methods  of  treatment,  are  to  be  regarded  as  having  been  given 
up  or  as  especially  difficult. 

Almost  all  impotent  individuals  (according  to  Fiirbinger, 
without  exception)  are  neurasthenic,  and  are,  therefore,  difficult 


114 


SEXUAL    IMPOTENCE   AND    ANESTHESIA. 


- 

BSS 

sEa 

£M>> 
HE 


a-o 
P 


feri 

OK 

-  a 

S! 

aa 

rH 

•  tnsiinqnreuraog 

•aouaiouraog    1  \    •H  ^ 

8 

'08-09 

•09-oe 

ri 

•Of-OS 
'OS-OS 
•OS-OT 
•OT-I 

00 

§   a   a   a  ^    .    •, 

w  o>2o;®i^s        SSSSS          c    »4     u     ^     h     ^ 

H  tf       T'L       Tl       C''.         »  *7l        *7!  *Q?        ^4         O         O         O         O          O         O 

«  MMMMgcs       %%AA%-BaaAAaa 

I    I    I    I    I    I       I§II§S|||J|I 

00060     Ssoogocioo'clooaa    -= » 
o,    a    a    a,    a,    c  2     6>    I      a    a     a    a     s     a    a    s    .2     5  a 

aaaasi^asaaaagaas.^^g; 

03     "  '      TO    .*"        '      u  g.S      ftS 

??     »5r     -S     -    -     .^     .!—O^^     »flOQ5     •  ^     «  ^     .5     •  5  2  •(-(     .^     .C^S^C'1"*'-] 

WQJWqjWqjj^qjQQjJ-^j'^O^t^.S^.qpCJ^OQJWQjC^+i^O^jQj        *tf>    P    flj    ^    I 

a  ^  gj  s  s  "'     "  "'  "'  ~'    ''  J  "'  "   "'  ~  ''  "' 


CONCLUDING    REMARKS.  115 

to  hypnotize.  The  increased  sensitiveness  to  auto-suggestion, 
the  result  of  irritable  weakness  of  the  brain,  may  be  regarded 
as  a  direct  symptom  of  the  neurasthenia.  The  inhibitory  im- 
perative idea  of  sexual  inability,  as  an  auto-suggestion,  especially 
resists  suggestion  from  without,  if  it  is  not  possible  so  to  mask 
the  psychical  procedure  that  the  brain,  in  spite  of  mistrust,  will 
accept  it;  or  if  the  psychical  erethism,  which  is  constantly  or 
occasionally  present  in  the  majority  of  neurasthenics,  prevents 
the  necessary  concentration  of  the  attention  and  the  beginning 
of  the  hypnotic  state.  To  hypnotize  neurasthenics  is  one  of  the 
most  difficult  tasks  for  the  psycho-therapeutist,  demanding  great 
circumspection,  practice,  patience,  and  time.  Only  after  forty 
sittings  (Case  31)  did  Moll  succeed  in  inducing  hypnosis  deep 
enough  to  permit  the  suggestive  induction  of  the  most  various 
hallucinations.  In  one  of  my  patients  (Case  33)  the  disincli- 
nation to  be  hypnotized  (probably  as  a  result  of  perverse  ideas 
connected  with  it)  was  so  great  that  the  patient  would  not  allow 
a  second  attempt.  In  another  case  (35)  the  patient  had  con- 
vinced himself  (auto-suggestion)  that  he  could  not  be  hypno- 
tized, and  I  required  the  assistance  of  chloroform.  This  im- 
perative idea  was  so  strong  that,  in  spite  of  partial  amnesia  after 
waking,  the  patient  declared  that  he  had  not  been  influenced  in 
the  least. 

The  word  "  hypnosis  "  and  the  prevalent  opinions  con- 
cerning it  lead  many  patients  to  believe  that  sleep  is  necessary 
for  the  success  of  the  therapeutic  suggestions ;  and  there  is  no 
idea  of  sleep  for  them  when,  after  waking,  they  remember  the 
events  of  the  hypnosis.  Though  sleep  favors  the  objectivity  of 
suggestions,  it  is  not  necessary,  and  actual  sleep  occurs  in  only 
about  a  third  or  a  fourth  of  all  patients  hypnotized.  Many 
somnambulists  are  minds  awake,  but  without  memory  after  the 
hypnosis ;  they  speak,  walk,  and  do  not  present  the  appearance 
of  sleep  in  any  way,  but  think  that  they  have  slept  because 
they  remember  nothing.  The  opposite  of  this  illusion  of  sleep 
is  presented  by  those  persons  who  actually  appear  to  sleep, — 
dream,  snore,  etc., — and  still,  after  waking,  protest  that  they 
have  not  been  really  asleep.  Such  patients  often  have  but  an 


116  SEXUAL   IMPOTENCE   AND   ANAESTHESIA. 

indistinct  memory  of  the  events  of  the  hypnotic  state,  and  are 
often  deceived  concerning  the  time  sleep  has  lasted.  How  little 
weight  is  to  be  given  to  the  memory  of  patients  in  this  state  of 
self-deception  is  shown  by  the  fact  that  suggestion  may  awaken 
or  destroy  post-hypnotic  memories.  The  word  "  hypnosis,"  in  its 
reference  to  sleep,  does  not  comprehend  clearly  enough  all  sug- 
gestive phenomena.  Therefore,  I  can  only  agree  with  Professor 
Bernheim  when  he  suggests  that  the  word  "  hypnosis  "  be  aban- 
doned, and  proposes  as  a  substitute  the  expression  "  state  of 
suggestibility." 

The  false  views  which  neurasthenics  especially  have  formed 
of  hypnotism,  which  they  often  look  upon  as  dangerous,  may 
be  the  starting-point  of  bad  effects  due  to  auto-suggestion, 
which,  however,  have  nothing  to  do  with  hypnosis  per  se.  In 
the  cases  reported  there  were  no  unfavorable  effects  of  any  kind  ; 
on  the  contrary,  in  cases  where  the  impotence  was  not  affected, 
the  influence  on  the  general  condition  and  nervous  symptoms 
was  favorable. 

After  the  details  set  forth  in  this  section  there  can  no 
longer  be  any  doubt  that,  if  need  be,  in  psychical  and  func- 
tional impotence,  suggestive  treatment  in  hypnosis  is  indicated 
as  the  most  effectual  procedure  in  psycho-therapeutics,  and  that 
henceforth  it  should  be  more  extensively  used  and  receive  more 
careful  consideration  than  heretofore. 


III.  SEXUAL  PA&ESTHESIA. 


CHAPTER   VII. 

THE  FORMS  OF  SEXUAL  PERVERSION  WITH  REFERENCE 
TO  THE  THEORY  OF  PROFESSOR  VON  KRAFFT-EBING. 

Definitions  and  Classification. — Von  Krafft-Ebing  desig- 
nates sexual  paraesthesia  as  the  excitability  of  the  sexual 
instinct  to  inadequate  stimuli.  Every  expression  of  sexual 
desire  which  does  not  correspond  with  the  purpose  of  nature — 
procreation — is  perverse.  This  manifestation  of  the  sexual 
impulse  often  occurs  in  connection  with  hypersesthesia,  and 
may  find  satisfaction  with  the  opposite  or  the  same  sex;  in 
accordance  with  which  von  Krafft-Ebing  distinguishes  hetero- 
sexual perversion  and  homo-sexuality.  The  impulse  toward 
the  same  sex  with  diminution  or  entire  absence  of  feeling  for 
the  opposite  sex  is,  in  accordance  with  Westphal's  l  suggestion, 
called  "  contrary  sexual  feeling."  By  this  expression  Westphal 
means  that  the  phenomenon  does  not  always  affect  simultane- 
ously the  sexual  desire  as  such,  but  that  merely  the  feeling,  the 
whole  inner  disposition,  becomes  different  from  that  of  the  sex, 
as  a  simultaneous,  undeveloped  degree  of  the  pathological  phe- 
nomenon. In  our  opinion,  to  which  we  shall  later  recur  in 
more  detail,  in  all  genuine  cases  of  contrary  sexual  feeling  the 
sexual  instinct  is  implicated ;  so  to  speak,  it  is  the  starting-point, 
the  centre  around  which  all  other  symptoms  are  grouped. 
Therefore,  changes  of  character  approximating  that  of  the 
opposite  sex,  without  implication  of  the  sexual  sphere,  do  not 
seem  to  us  to  deserve  the  name  of  contrary  sexual  feeling. 

In  the  manifestations  of  paraesthesia  sexualis,  according  to 
their  practical  significance,  we  differentiate  two  groups: — 

I.  Inversion  of  the  sexual  feeling  (contrary,  or  homo-sexual, 
feeling). 

1  Westphal,  "  Contrare  Sexualempfindung,"  Archiv  fur  Psychiatric,  Berlin,  1869, 
Bd.  ii,  Heft  1,  p.  107. 

(117) 


118  SEXUAL    PAR^STHESIA. 

II.  Perverse  activity  of  the  sexual  impulse  (without  refer- 
ence to  the  object.) 

I.  Inversion  of  Sexual  Feeling? — Group  I  is  divided  by 
von  Krafft-Ebing  into  two  important  classes : — 

(a)  Acquired  abnormal  contrary  sexual  feeling. 

(&)  Congenital  abnormal  contrary  sexual  feeling. 

The  prerequisite  for  the  development  of  homo-sexuality  is 
a  neuropathic  nervous  system  (Moll  and  von  Krafft-Ebing), 
which  may  be  either  acquired  or  congenital.  Besides  the  pre- 
disposing cause, — the  neuropathic  condition,  according  to  von 
Kraffb-Ebing, — there  must  be  an  exciting  cause,  to  induce  the 
manifestation  of  contrary  sexual  feeling.  According  to  the  same 
author,  as  an  acquired  abnormal  phenomenon,  it  occurs  but  in- 
frequently. He  gives  only  four  cases 2  as  the  result  of  cultiva- 
tion, in  contrast  with  forty-three  cases  in  which  inheritance  plays 
a  role.  Acquired  contrary  sexual  feeling  passes  through  the 
same  stages  as  does  the  congenital.  In  development  the  fol- 
lowing varieties  are  to  be  differentiated  (von  Krafft-Ebing) : — 

1.  With    predominating    homo-sexual    feeling    there    are 
traces  of  hetero-sexual  feeling  (psycho-sexual  hermaphroditism). 

2.  There  is  inclination  only  toward  the  same  sex  (homo- 
sexuality), horror  feminse  (limited  to  the  vita  sexualis). 

3.  The  whole    mental    existence    (character)    corresponds 
with  the  abnormal  sexual  feeling  (effemination  and  viraginity 3). 

1  In  the  eighth  edition  of  Psychopathia  Sexualis,  von  Krafft-Ebing  distinguishes  four 
stages  in  the  process  of  transformation  of  sexual  feeling  : — 

I  Degree  :  Simple  inversion  of  the  sexual  feeling.     The  patient  is  still  in  an  active 
rdk,  and  looks  upon  the  impulse  toward  the  same  sex  as  an  aberration. 

II  Degree  :   Eviration  and    defemination.      Transformation  of  the    character,  the 
feelings,  and  the  inclinations  to  those  of  a  female,  or  vice  vers&. 

III  Degree  :   Transformation   to  metamorphosis   sexualis   paranoica.      The   bodily 
feeling  changed  in  the  sense  of  a  transmutatio  sexus. 

IV  Degree  :  Metamorphosis  sexualis  paranoica.     Delusion  of  sexual  transformation. 
"In  Moll's  opinion  (loc.  cit.,  p.  157)  of  these  four  cases,  three  are  not  proof  of  the 

theory  of  cultivation,  for  in  them  there  were  traces  of  perversion  during  childhood  and 
puberty. 

*  Tarnowsky  (Die  krankhaften  Erscheinungen  des  Geschlechtssinnes,  Berlin,  1886, 
pp.  11-14)  describes  the  development  of  effemination  as  follows  :  "  The  first  expression  of 
shame  is  not  in  relation  to  girls  or  women,  but  toward  grown  men.  The  boy  is  ashamed  to 
undress  before  a  grown  man.  Dreams  with  pollutions  are  of  embracing,  kissing,  and 
caressing  men.  Owing  to  the  irritable  weakness  of  these  subjects,  their  love  is  violent 
and  passionate.  The  youth  is  actuated  by  the  desire  to  appear  feminine,  loves  to  put  on 
female  attire,  to  wear  his  hair  long,  and  to  go  about  with  open  neck  and  laced  waist ;  he 


FORMS  OF  SEXUAL  PERVERSION.  119 

4.  The  bodily  form  approaches  that  with  which  the  abnor- 
mal sexual  feeling  corresponds.  There  is  never,  however, 
actual  hermaphroditism  (androgyny  and  gynandry).  Femi- 
nine type  (broad  hips,  rounded  form,  abundant  development  of 
adipose  tissue,  growth  of  beard  spare  or  absent,  feminine 
features,  fine  complexion,  falsetto  voice)  in  the  male ;  develop- 
ment of  mammae,  with  production  of  milk  at  puberty  (Case  80, 
"  Psychopathia  Sexualis  "). 

As  the  most  important  influences  contributing  to  the  de- 
velopment of  acquired  contrary  sexual  feeling,  the  authorities 
mentioned  enumerate :  excessive  masturbation,  which  injures 
character,  instincts,  and  nervous  system,  and  leads  to  mutual 
masturbation ;  and  fear  of  pregnancy  and  venereal  infection. 
Moll  regards  as  acquired  contrary  sexual  feeling  only  those  cases 
where  there  was  first  manifested  an  inclination  toward  women, 
and  later  toward  men. 

When  the  inversion  of  sexual  feeling  appears  as  a  partial 
manifestation  of  a  "  neuro-psychopathic "  condition  which  is 
hereditary,  the  following  signs  are,  according  to  von  Krafft- 
Ebing's  theory,  distinctive : — 

(a)  Premature  awakening  of  the  sexual  instinct. 

(&)  Enthusiastic  exaltation ;  overpowering  strength  of 
desire ;  sexual  hypersesthesia. 

(c)  Functional  and  anatomical  signs  of  degeneration. 

(d)  Neuroses    (hysteria,   neurasthenia,  epileptoid   states) ; 
irritable  weakness  of  the  lumbar  portion  of  the  spinal  cord. 

(e)  Psychical  anomalies  (original  eccentricities  and  deficient 
intellect,  with  one-sided  mental  endowment),  even  to  the  extent 
of  weak-mindedness  and  moral  insanity. 

likes  to  perfume  and  powder  himself,  and  to  paint  and  pencil  the  eyebrows.  There  is 
developed  that  type  of  feminine  male  so  disgusting  to  men  and  so  repugnant  to  women, 
whom  it  is  not  difficult  to  recognize  in  the  outward  appearance.  Of  medium  or  small 
build ;  with  broad  pelvis,  narrow  shoulders,  feminine  gait,  and  a  peculiar  movement  of 
the  hips;  with  smoothed  locks  and  ludicrous  attire,  the  arms  bearing  bracelets;  with 
smirks  and  gestures  and  volubility,  they  seek  to  attract  the  attention  of  men.  The  unfor- 
tunate creature,  especially  if  he  have  a  relatively  weak  mental  endowment,  does  not 
understand  that  he  is  the  more  disgusting  to  normal  men  the  more  he  seeks  to  imitate 
women.  Since  he  is  whimsical  to  the  verge  of  hysteria,  cowardly,  pusillanimous,  vindict- 
ive, and  willful,  he  unites  in  himself  all  the  defects  of  woman  without  her  virtues,  and 
possesses  not  a  single  one  of  the  attractive  features  of  the  male  character.  Therefore,  he 
is  as  repulsive  to  men  as  to  women." 


120  SEXUAL    PAK^ESTHEStA. 

(/)  Neuroses,  psychoses,  and  signs  of  degeneration  in 
progenitors. 

"  The  hereditary  element  is  the  acquired  abnormal  inclina- 
tion to  the  same  sex,  which  in  descendants  is  manifested  as  a 
congenital  abnormal  phenomenon."  This  hypothesis  is  sup- 
ported by  the  facts  that  mental  peculiarities  and  defects  may 
be  transmitted,  and  that  individuals  of  contrary  sexuality  may 
beget  children.  In  an  observation  by  von  Krafft-Ebing,  father 
and  son  are  affected  with  contrary  sexuality. 

According  to  von  Krafft-Ebing,  the  first  three  degrees  of 
congenital  contrary  sexual  feeling  correspond  genetically  with 
the  developmental  stages  of  the  acquired  anomaly. 

The  most  frequent  sexual  acts  in  which  such  individuals 
find  satisfaction  are :  coitus  inter  femora,  in  anum.  in  os ; 
mutual,  psychical,  and  tactile  onanism ;  simple  caresses ;  exhi- 
bition. Enforced  intercourse  with  a  woman  is  burdensome, 
while  inadequate  homo-sexual  acts  afford  complete  satisfaction. 
As  a  rule,  there  is  no  inclination  toward  immature  individuals. 

In  homo-sexual  intercourse  the  perverse  activity  of  the 
sexual  instinct  may  take  the  same  form  as  in  hetero-sexual 
relations ;  the  manner  of  expression  of  the  instinct  and  the 
excitation  of  it  by  means  of  partial  impressions  coming  from 
the  beloved  object  are  the  essential  elements,  while  the  sex  of 
the  individual  giving  rise  to  the  impressions  is  subsidiary. 

According  to  von  Krafft-Ebing's  brilliant  explanations,  in 
the  various  forms  of  this  anomaly  the  combination  of  lust  and 
cruelty  is  very  striking.  The  two  most  intense  emotions,  love 
and  anger,  seek  to  expend  themselves  physically  on  their  object ; 
both  throw  the  psychomotor  sphere  into  violent  excitement,  and 
through  this  excitement  attain  their  normal  expression.  Exal- 
tation of  the  sexual  emotion  induces  intense  excitation  of  the 
whole  psychomotor  sphere,  and  gives  rise  to  the  impulse  to 
exhaust  itself  in  senseless  and  seemingly  hostile  acts,  which  are 
to  be  regarded,  in  a  measure,  as  accompanying  psychical  emo- 
tions. The  most  powerful  means  with  which  to  affect  an  indi- 
vidual are  those  which  inflict  pain.  The  aggressive  role  of  the 
man  may,  where  there  is  defect  of  moral  feeling  and  absence  of 


FORMS   OF   SEXUAL   PERVERSION.  121 

normal  deterrents,  become  so  intensified  as  to  end  in  the 
murder  of  the  object  of  love.  This  pathological  intensification 
of  the  manifestations  accompanying  the  vita  sexualis,  following 
French  usage,  von  Krafft-Ebing  designates  sadism.  Acts  of 
violence  are  colored  with  lustful  feelings. 

Pathological  predominance  of  the  specific  feminine  ele- 
ment, the  instinct  of  subordination,  to  the  extent  of  desire  to 
endure  pain  and  to  submit  absolutely  to  its  power  to  the  extent 
of  experiencing  lustful  pleasure  in  abuse  (overcompensation  of 
physical  pain  by  psychical  lust),  the  same  author  calls  masochism. 

The  terms  sadism  and  masochism  are  derived  from  the 
names  of  the  novelists,  Marquis  de  Sade  and  Sacher-Masoch, 
who  described  the  perversions.  Even  should  these  terms  be 
adopted, — although  they  do  not  follow  the  usual  rules  of 
scientific  terminology, — it  seems  essential  to  form  a  word  the 
composition  of  which  shall  indicate  the  nature  of  these  sexual 
anomalies.  Such  a  word  is  offered  in  the  term  algolagnia^  or 
algolagny,  derived  from  d/l^o$  =  pain  (adopted  medically  in  this 
sense,  as  in  analgesia,  cephalalgia,  and  neuralgia)  and  hayvog  = 
sexually-excited  lust ;  from  the  latter  hayvsLa  is  derived,  used 
by  Hippocrates  and  Aristotle  in  the  sense  of  seminal  emission, 
by  Xenophon  in  the  sense  of  lust  (Max  Offner *).  While  algo- 
lagnia would  designate  the  combination  of  cruelty  and  lust  as  a 
special  variety  of  sexual  perversion,  active  algolagnia  would 
signify  sadism,  and  passive  algolagnia  masochism  (masochist  = 
passive  algolagnist,  and  masochistic  =  passively  algolagnistic). 

Lustful  pleasure  in  inflicting  pain  and  lustful  pleasure  in 
the  endurance  of  pain  are  but  two  aspects  of  the  same  mental 
process,  of  which,  according  to  von  Krafft-Ebing,  the  essential 
element  is  the  consciousness  of  active  or  passive  subjection. 
Passive  algolagnia  in  a  man  is  the  development  of  a  sexual 
characteristic  which,  in  accordance  with  her  nature,  belongs  to 
woman,  and  it  is  to  be  regarded  as  partial  effemination  or  rudi- 
mentary contrary  sexual  feeling.  Cruel  acts  are  the  most  in- 
tense means  with  which  to  express  the  relation  of  subjection. 

1  Max  Offner,  whose  philological  knowledge  assisted  in  the  formation  of  the  above 
word,  also  proposed  the  terms  "  aekialagnia  "  =  masochism,  and  "  aekizolagnia  "  =  sadism 
(from  aUta  and  aiVt£u>),  but  they  seem  to  me  less  suitable. 


1 22  SEXUAL    PAR^ISTHESIA. 

Though  active  and  passive  flagellation  is  the  means  most  fre- 
quently used  as  an  excitant  by  algolagnists,  still  there  are  other 
cases  in  which  the  relation  of  subjection  is,  to  a  certain  extent, 
indicated  symbolically,  and  as  an  accessory  group  of  psychical 
liermaphroditism  are  those  cases  in  which  the  passive  inclina- 
tions of  algolagnia  are  combined  with  others  that  are  active. 

The  last  group  of  phenomena  of  paraesthesia  sexualis  is 
designated  "erotic  fetichism"  (von  Krafft-Ebing  and  Binet),  i.e., 
individual  valuation  of  the  fetich — a  part  of  the  beloved  person 
— to  the  extent  of  actual  enthusiasm.  Here  the  essential  ele- 
ment is  the  emotional  coloring  of  the  idea  of  a  portion  of  the 
beloved  person,  in  a  sense  of  sexual  pleasure,  which  is  peculiar 
to  the  individual.  For  the  development  of  this  form  hyperaes- 
thesia  is  necessary,  and  the  substitute  for  coitus  is  usually  found 
in  onanistic  acts. 

Von  Krafft-Ebing  avails  himself  of  Binet's  theory  of  associ- 
ation to  explain  this  variety  of  perversions.  Sensual  excitement 
occurs  simultaneously  with  the  sight  of  a  portion  of  the  beloved 
person.  Sensory  and  optical  impressions  are  associatively  con- 
nected, and  this  connection  is  confirmed  in  proportion  as  fre- 
quent repetition  of  the  feeling  arouses  the  optical  memory- 
picture.  The  fetich  is  an  individual  symbol  which  induces 
sexual  excitement.  It  may  consist  of  («)  a  portion  of  the 
body  (hand,  foot,  hair) ;  (&)  peculiar  mental  characteristics ;  (c) 
lifeless  objects,  articles  of  use  which,  as  a  rule,  originally  stood 
in  some  relation  to  "a"  (derived  from)  ;  as,  for  example,  aprons 
and  shoes.  Von  Krafft-Ebing,  however,  classifies  shoe-fetichists 
as  masochists  (passive  algolagnists),  because  the  act  of  allowing 
one's  self  to  be  trod  upon  expresses  masochistic  desires. 

Fetichism  becomes  pathological  as  soon  as  it  is  no  longer 
exclusively  a  means  of  attraction,  but  a  conditio  sine  qua  non 
of  virility  (von  Krafft-Ebing). 

The  foregoing  resume  includes  all  the  essential  forms  of 
paraesthesia  sexualis  in  accordance  with  the  classification  of  von 
Krafft-Ebing,  with  their  various  distinctive  features,  and  suffices 
for  this  work  and  the  following  chapters,  the  purpose  of  which 
is  to  modify  and  enlarge  this  theory  in  some  particulars. 


CHAPTER  VIII. 

HISTORY  OF  THE  DEVELOPMENT  OF  CONTRARY  SEXUAL 
FEELING  AMONG  THE  ANCIENTS. 

IN  order  to  form  a  judgment  concerning  contrary  sexual 
feeling, — that  is,  with  reference  to  prognosis  and  therapy, — its 
etiology  is  of  the  utmost  importance.  The  causes  and  the  con- 
ditions of  development  of  this  pathological  phenomenon  are  to 
be  studied  not  only  in  the  individual,  but  it  is  of  the  highest 
scientific  interest  to  understand  the  influences  which,  in  the 
history  of  peoples,  caused  and  favored  this  perverse  activity  of 
the  sexual  instinct.  For  we  find  love  between  persons  of  the 
same  sex  in  all  times  and  among  all  peoples. 

Age  and  Extent  of  Sexual  Inversion. — In  ancient  times 
Asia  was  looked  upon  as  the  land  of  origin  of  pederasty. 
From  here  it  spread  westward.  The  most  ancient  historical 
sources  give  evidence  of  the  existence  of  the  vice  in  question. 
But  the  first  discoverers  of  America  found  the  vice  among  the 
aborigines.  Thus,  it  was  generally  spread  throughout  the 
inhabitants  of  Panama ; *  in  northern  Mexico  marriages  took 
place  between  men,  and  those  who  were  dressed  as  women  were 
forbidden  to  bear  arms.  Travelers  in  North  America 2  found 
among  the  aborigines  men,  attired  like  women,  doing  feminine 
household  duties.  According  to  Mantegazza,  pederasty,  mostly 
in  the  form  of  male  prostitution,  is  spread  among  the  natives 
of  Alaska,  Darien,  the  Aleutians,  Madagascar,  etc. ;  and,  ac- 
cording to  Hammond,3  it  is  made  use  of  for  religious  purposes 
by  the  Pueblo  Indians  of  New  Mexico.  On  the  island  of 
Ramrih,4  on  the  other  hand,  women  acted  like  men  in  order  to 
stand  at  the  head  of  affairs,  and  attached  themselves  to  other 
women,  with  whom  they  lived  as  man  and  wife. 

1  Mantegazza,  Anthropologisch.  culturhistorische  Studien  uber  die  Geschlechtever- 
haltuisse  der  Menschen,  Jena,  Costenoble,  p.  118. 

a  This  vice  is  so  little  the  product  of  excessive  civilization  that  it  has  been  met  in 
North  America.  Comp.  Virey,  Historic  naturelle  du  genre  humain,  Paris,  1824,  vol.  1, 
p.  273. 

1  Hammond,  op.  cti. 

4  Sitzung  der  Berl.  Psychol.  Ges.  vom.  15  Okt.,  1868. 

(123) 


124  SEXUAL    PAR^STHESU. 

In  his  work,  "  Contrare  Sexualempfindung  "  (Berlin,  Korn- 
feld,  1891),  Dr.  Moll  gives,  in  its  essential  points,  a  resume  of 
the  history  of  contrary  sexual  instinct,  which,  beginning  with 
the  Bible  and  Greek  mythology,  he  traces  through  ancient  litera- 
ture (Greece  and  Rome)  to  the  cloister-life  of  the  middle  ages, 
and  thence  to  modern  times,  giving  interesting  facts  concerning 
historical  personages  who  are  under  the  suspicion  of  uranism 
(e.g.,  Rudolf  of  Hapsburg,  Michael  Angelo,  Shakespeare,  Hein- 
rich  von  Kleist,  and  others.).  To  avoid  unnecessary  repetition, 
I  may  permit  this  reference  to  suffice,  and  allow  the  reader  to 
peruse  for  himself  the  exceedingly  instructive  historical  portion 
of  that  work.  The  following  statements,  however,  come  in  place 
here,  since  they  are  either  deviations  from  the  opinions  of  that 
writer  or  additions  to  his  material. 

Historical  Conditions  of  Development. — History  and  folk- 
lore show  that  there  has  been  spontaneous  and,  to  a  certain 
extent,  idiopathic  occurrence  of  male-love1  and  pederasty  among 
various  peoples  and  at  various  times,  where  there  has  been  no 
possibility  of  a  spread  of  the  disease  by  means  of  communica- 
tion between  the  natives  of  various  regions  of  the  globe. 
Uranism  occurs  as  the  product  of  a  special  development,  for 
which  the  conditioning  causes  must  be  given  in  the  relation  of 
the  sexes  and,  perhaps,  too,  in  climatic  conditions. 

Most  authors,  especially  Moll,  state  that  the  most  impor- 
tant etiological  influence  in  contrary  sexual  instinct  is  degenera- 
tion of  the  central  nervous  system,  as  that  is  understood  with 
reference  to  neurotic  or  psychical  taint.  To  be  sure,  it  cannot 
be  gainsaid  that  the  majority  of  contrary  sexual  individuals  are, 
at  the  same  time,  neuropathic.  But  this  explanation  does  not 
show  why  the  degeneration  must  be  expressed  in  this  kind  of 
sexual  perversion.  Moreover,  it  is  quite  possible  that  the 
neuropathy  occurs  as  a  result  of  the  feminine  role.  Finally,  it 
seems  to  me  by  no  means  demonstrated  that  savage  peoples  in 
which  homo-sexuality  occurs  manifested  primarily  a  neuropathic 
disposition,  upon  which  this  vice  was  secondarily  engrafted;  it 

1  Contrary  sexual  instinct  in  women  never  attained  such  practical  importance, 
socially  or  medically,  as  it  has  in  men.  Therefore,  in  this  book,  it  receives  but  subsidiary 
treatment. 


CONTRARY    SEXUAL   FEELING    AMONG   THE    ANCIENTS.          125 

is  necessary  to  show  other  signs  of  degeneration  in  them.  And 
why  must  just  this  single  deviation  of  the  sexual  instinct  occur 
primarily  as  a  sign  of  a  neuropathic  or  psychopathic  state"? 
Why  not,  with  the  same  right,  include  all  the  other  sexual 
vices  which  the  lively  fancy  of  sensual  Asiatics  created,  deified 
in  the  cult  of  Lingam  and  Phallus,  and  worshiped  in  the  most 
licentious  way  in  orgies  in  honor  of  Astarte  (or  Mylitta)  I  To 
make  hereditary  disposition  alone  or  principally  account  for  the 
origin  of  contrary  sexual  instinct  is  to  push  back  the  riddle  and 
regard  it  as  atavistic,  but  not  to  solve  it.  Then,  the  question 
is :  What  circumstances  first  caused  the  savage  to  seek  gratifi- 
cation of  his  instinct  in  intercourse  with  his  own  sex  ?  For,  as 
with  other  hereditary  peculiarities,  it  is  certain  that  in  the 
developmental  history  of  man  pederasty  must  once  have  been 
primarily  acquired. 

In  proportion  as  the  natural  purpose  of  coitus,  procreation, 
gave  place  to  lustful  lasciviousness,  as  we  again  and  again 
find  in  folk-lore  that  it  has,  the  usual  manner  of  gratification 
lost  the  stimulus  of  novelty.  The  effort  to  bring  about  varia- 
tions of  the  simple  act  of  coitus  called  to  life  the  theories  of  an 
unnatural  Venus  (Venus  illegitima),  in  which,  according  to 
Rosenbaum,1  every  trace  of  the  real  purpose  of  the  genitals 
finally  disappeared.  Wherever  the  impressionability  of  the 
genital  centres  has  become  weakened  or  dulled  by  sexual 
excess,  we  see  that  the  human  imagination  seeks  new  and  more 
intense  means  of  stimulation  in  order  to  bring  about  the  desired 
gratification.2  Thus,  for  example,  to-day  there  is  scarcely  a 
doubt  that  tribadism  is  most  frequently  encountered  among 
prostitutes,  and  that,  too,  without  the  necessity  of  any  previous 
predisposition.  Moll  cannot  account  for  the  transition  to  the 
same  sex ;  still,  the  experiences  in  prisons  show  that  unsatisfied 
sexual  desire  resorts,  faute  de  mieux,  to  immediate  compan- 

1  Ploss  (Das  Weib,  Leipzig,  1891,  p.  315)  also  shows  that  the  lower  a  people  is,  the 
more  disgusting  the  expression  of  their  lust  and  animal  sensuality  becomes.  Many  primi- 
tive peoples  made  use  of  excessive  means  of  excitation  in  order  to  incite  feminine  lust. 
As  Cubary  states,  "  On  the  island  of  Ponape,  some  men  go  so  far  as  to  place  a  piece  of  fish 
in  the  wife's  vulva,  so  that  they  may  gradually  eat  it  out.  This  revolting  act  is  continued 
until  the  wife  begins  to  urinate,  and  then  coitus  is  performed." 

1  Rosenbaum,  Geschichte  der  Lustseuche,  1888,  p.  119. 


126  SEXUAL    PAR^ESTHESIA. 

ions,  and  that  mutual  onanism  and  pederasty  are  frequently 
met  in  penitentiaries  among  relatives  of  the  same  sex.  Here, 
at  least,  the  original  of  primary  homo-sexual  pederasty  forms 
the  transition  to  pedicatio  mulierum.  This  view  also  finds 
support  in  historical  sources,  which,  however,  are  anything  but 
abundant. 

Pederasty  as  a  Cause  of  Homo-sexuality  and  Castration. 
— In  Asia,  as  in  Italy  and  Spain,  the  female  genitals,  like  the 
whole  body,  are  greatly  relaxed.1  The  sphincter  ani  is  much 
more  powerful  than  the  constrictor  cunni.  And,  with  respect 
to  this,  we  may  consider  Forberg's2  statement:  "  Et  voluptas 
quidem  paediconis  facile  intelligitur,  cum  omnis  voluptas  men- 
tula3  pendeat  ex  frictione."  The  following  passage  from  Paul's 
Epistle  to  the  Romans  (chap,  i :  24,  26,  27)  also  indicates  that 
psedicatio  mulierum  preceded  actual  pederasty :  "  Wherefore 
God  also  gave  them  up  to  uncleanness,  through  the  lusts  of 
their  own  hearts,  to  dishonor  their  own  bodies  between  them- 
selves :  for  even  their  women  did  change  the  natural 
use  into  that  which  is  against  nature :  And  likewise  also  the 
men,  leaving  the  natural  use  of  the  woman,  burned  in  their  lust 
one  toward  another ;  men  with  men  working  that  which  is 
unseemly." 

After  the  unusual  manner  of  obtaining  gratification  with 
women  had  once  been  exhausted,  the  feminine  appearance  of 
boyhood  gave  a  new  charm.  Therefore,  still  to-day,  as  formerly, 
active  pederasts  prefer,  as  a  rule,  beautiful  boys  of  an  age  when 
the  masculine  characteristics  (beard,  voice,  etc.)  have  not  yet 
become  pronounced.  "  They  have  the  same  glance,  the  same 
delicacy  of  skin  and  form,  the  same  breath  of  innocenoe  as  the 
maiden  "  (Max  Dessoir).  Next,  only  feminine  charms  in  the 
male  person  became  attractive,  which,  on  account  of  the  peculiar 
combination,  were  especially  enticing  to  persons  with  perverse 
inclinations.  In  this  way  pederasty  with  males  was  learned, 

1  Comp.  Martialis,  lib.  xl,  Epigrams  28  and  79. 

*  Autonii  Panormitae  Hermaphroditus,  ed.  F.  C.  Forberg.  The  apophoreta  of  the 
editor  treats  of  "  De  flguris  veneris,"  "  De  fututione,"  "  De  paedicatione,"  "  De  irru- 
mando,"  "  De  masturbando,"  "  De  cunnilingis,"  "  De  tribadibus,"  "  De  coitu  cum 
brutis,"  "  De  spintris."  Comp.,  also,  Roseubaum,  loc.  cit.,  p.  121. 


CONTRARY   SEXUAL   FEELING   AMONG   THE   ANCIENTS.         127 

and  from  it,  later,  arose  castration  and  gynandry.  The  degen- 
erative transformation  of  the  male  character  while  in  the  stage 
of  development  (puberty)  first  occurred  as  a  result  of  adaptation 
to  the  necessary  role.  Therefore,  the  sexual  instinct  became 
transformed  secondarily  as  a  result  of  artificial  cultivation. 
Effemination  is,  therefore,  originally  a  phenomenon  resulting 
from  pederasty,  and  then,  where,  in  spite  of  the  sexual  trans- 
formation, procreation  took  place,  it  may  have  exercised  heredi- 
tary influence.  With  this  view,  the  following  citation  from 
Lucian  (Amor,  chaps,  xx,  xxi)  is  of  interest  in  connection  with 
the  history  of  pederasty  : — 

"  Gradually  descending  from  the  height  of  morality  into 
the  abyss  of  sensuality,  strange  and  unusual  manners  of  gratifi- 
cation were  practiced.  Debauchery,  which  attacked  everything, 
transgressed  even  the  laws  of  nature,  and  a  man  was  taken  for 
a  woman.  Either  animal  passion  was  satisfied  by  force  or 
cunning  was  used  to  obtain  consent.  One  of  the  same  sex 
thus  placed  himself  in  the  power  of  another.  But  to  each  the 
sight  of  his  own  sex  in  his  companion  did  not  cause  him  to  be 
ashamed  of  what  he  did  or  permitted.  The  boldness  of  some, 
in  their  despotic  manner  of  life,  went  so  far  that  they  robbed 
themselves  of  masculinity  with  the  knife.  They  reached  the 
goal  of  their  sensual  desires  only  when  they,  as  men,  had 
removed  their  manhood.  But  the  unfortunates,  in  remaining 
boys  longer,  are  no  longer  men, — an  equivocal  expression  of  a 
double  nature ; '  for  they  know  not  to  what  they  were  born  nor 
what  they  are,"  etc.  Gradually,  in  Asia,  pederasty  became 
embodied  in  the  worship  of  Venus. 

According  to  the  excellent  descriptions  by  Rosenbaum,  the 
expressions  svvov%oi  and  avfyoyvvoi  at  first  signified  nothing 
but  "  Kinaden  "  or  "  Pathici," — i.e.,  persons  who  sacrificed 
themselves  in  the  temple  in  honor  of  the  deity.1  Thus  is 
explained  the  teaching  of  the  priests  of  Cybele,  who  emasculated 
themselves,  it  is  said,  in  honor  of  the  deity. 

1  Later,  in  Rome,  the  term  "  exoleti "  (castrated)  was  used  In  the  same  sense. 
Comp.  Aristotle,  Polit,  v,  8,  9.  This  fact  seems  to  be  little  known.  Thus,  Mantegazza. 
who  has  written  a  long  chapter  upon  sexual  mutilation,  does  not  mention  it.  Comp. 
Anthropol.  Kult.-St.,  p.  132. 


128  SEXUAL    PARJESTHESIA. 

According  to  Hellicanus,1  the  practice  of  emasculating  boys 
was  derived  from  the  Babylonians.  The  origin  of  the  custom  is 
attributed  to  Semiramis.2  Still,  as  Steut 3  believes,  it  is  proba^ 
bly  much  more  ancient.  Herodotus  states  (iii,  92)  that  the 
Babylonians  were  required  to  send  the  Persian  kings  each  year 
five  hundred  eunuchs  as  tribute.  At  any  rate,  the  traffic  in 
eunuchs  was  very  wide-spread.  Tavernier  relates  (according  to 
Steut,  p.  8)  that  \n  the  kingdom  of  Bootan  twenty  thousand 
eunuchs  were  made  every  year  to  be  sold  to  other  nations. 
Philo 4  also  holds  to  the  opinion  that  castration  was  principally 
a  result  of  pederasty.  "  Some  had  such  esteem  for  youthful 
beauty  that  they  (the  androgynists)  desired  complete  transforma- 
tion into  females,  amputated  the  penis,  dressed  themselves  in 
purple  garments,  etc."  Only  at  a  later  period  was  castration 
practiced  after  maturity  had  been  attained,  so  that  eunuchs 
could  still  the  erotic  desires  of  women  without  the  possibility 
of  producing  pregnancy  (Rosenbaum). 

Eunuchism. — Steut,  who,  in  his  work,  "  Chinese  Eunuchs," 
describes  in  detail  the  character,  habits,  duties,  and  preparation 
of  the  Chinese  eunuchs,  does  not  once  mention  their  sexual 
intercourse  with  men  ;  but  he  gives  interesting  explanations  of 
the  inner  and  outer  transformations,  in  the  sense  of  efFemination, 
which  occur  in  the  eunuchs.  He  says  (p.  38):  "All  eunuchs 
lose  their  natural  voice ;  those  that  have  been  subjected  to  the 
operation  in  childhood  have  a  voice  which  can  scarcely  be  dis- 
tinguished from  the  voice  of  a  young  woman,  while  those  so 
treated  after  reaching  maturity  speak  in  a  kind  of  broken  fal- 
setto. In  general,  the  Chinese  are  not  troubled  with  an  abun- 
dance of  hair,  but  the  eunuchs  are  devoid  of  even  the  slightest 
trace  of  hair  on  the  face.  If  one  be  possessed  of  a  beard  at 
the  time  of  his  castration,  the  hair  gradually  falls  out,  and, 
finally,  the  face  is  as  smooth  as  a  billiard-ball.  It  is  scarcely 
necessary  to  mention  that  on  the  face  of  those  castrated  in 
childhood  hair  of  no  kind  ever  appears."  When  operated 

1  Donat.  Terent.  Eunuch.,  i,  2,  87. 

3  Marcell,  xiv,  6. 

'Steut,  Chinesische  Eunuchen  (Leipzig,  Schulze),  p.  6. 

4  Philo,  Opera,  ed.  Maugeg.,  ii,  p.  465. 


CONTRARY   SEXUAL   FEELING   AMONG   THE   ANCIENTS.         129 

upon  early,  eunuchs  often  become  corpulent,  but  their  flesh  is 
soft  and  relaxed.  With  advancing  years  they  become  thinner 
and  terribly  wrinkled.  Castration  seems  to  rob  them  of  all 
that  is  manly ;  they  grow  old  rapidly,  and  at  the  age  of  40  look 
to  be  60  years  old. 

In  the  performance  of  certain  natural  acts,  eunuchs  are 
very  modest ;  and  they  will  endure  great  inconvenience  until 
they  gain  an  opportunity  to  perform  them  unobserved.  "  This 
peculiarity  is  the  more  to  be  praised,  since  usually  the  Chinese 
are  not  in  the  least  embarrassed  when  observed  under  such  cir- 
cumstances." They  are  not  at  all  blood-thirsty,  but  much 
rather  the  opposite.  Harmless  and  affectionate,  they  love  all 
sorts  of  amusement.  The  slightest  thing  moves  them  to  tears. 
They  are  loving  to  women  and  children,  and  exceedingly  kind 
to  the  little  dog  with  which  almost  every  one  is  provided.  In 
spite  of  their  timorousness,  they  are  irritable  and  excitable  and 
cross,  like  women,  but  they  are  easily  appeased ;  a  trifle  which 
another  person  would  scarcely  notice  may  throw  them  into  an 
ungoverned  rage.  In  general,  the  appearance  of  eunuchs  may 
be  called  repulsive;  yet  young  eunuchs  are  often  very  pretty 
and  feminine.  In  fact,  they  might  be  taken  for  young  women 
in  male  attire.  As  they  grow  older,  one  cannot  help  thinking 
that  they  resemble  old  women  that  have  forgotten  their  sex  and 
age  and  masquerade  in  the  garments  of  the  opposite  sex.  Too, 
they  may  be  recognized  at  a  distance  by  their  gait.  They  take 
short  steps,  and  hold  the  legs  close  together.  In  this  way  an 
independent  observer  describes  the  complete  effemination  of  the 
eunuchs  resulting  from  castration,  without  recognizing  the 
original  object, — i.e.,  the  cultivation  of  the  female  type  in  the 
male  body  for  the  purpose  of  pederasty. 

Another  reason  for  the  occurrence  of  pederasty  may  be 
found  in  a  deficiency  in  the  number  of  women  and  in  dif- 
ficulties in  the  performance  of  coitus.  Mantegazza1  seems  to 
have  stated  the  truth  when  he  says :  "  The  errors  of  physical 
love  all  originate  in  two  sources, — either  in  the  difficulty  or 
impossibility  of  gratifying  it  in  the  natural  way,  or  in  the  desire 

1  Mantegazza,  loc.  ctt. ,  p.  106. 
9 


130  SEXUAL     PAR^ESTHESIA. 

to  experience  a  new  pleasure.  That,  in  simple  words,  is  the 
psychology  of  sexual  vice,  from  Sodom  to  Lesbos,  from  Babylon 
to  the  island  of  Capri." 

The  Historical  Origin  of  Uranism  in  Europe. — The  Jews 
seem  to  have  become  acquainted  with  boy-love  in  Syria.1  Ac- 
cording to  ancient  authorities,  the  Persians,2  the  Celts,3  and  even 
the  Germans4  were  acquainted  with  it.  Pederasty,  as  already 
mentioned,  was  most  practiced  in  ancient  Babylon,  in  Sodom,5 
and  by  the  inhabitants  of  Tyre.6  From  Asia  uranism  was 
spread  by  the  Phoenicians  or  Lydians7  (Welcher)  first  to  Crete, 
and  from  there  over  all  Greece.8  According  to  Suidas,9  the 
Italians  were  again  the  discoverers  of  boy-love,  which  was  prac- 
ticed in  the  most  vicious  manner,  especially  by  the  Etruscans, 
Samites,  and  Messipians.  In  the  year  433 10  after  the  founding 
of  Rome,  this  vice  was  practiced  there.  In  the  year  585 
(B.C.  169),  on  the  other  hand,  the  Lex  scantinia11  was  promul- 
gated, which  is  indicative  of  the  great  extent  of  pederasty. 

During  the  Empire,  as  is  known,  this  vice  took  on  an 
unrestrained  character,  and  the  horrible  scenes  under  Nero, 
Tiberius,  and  Caligula  mock  all  description.12 

Greek  Boy-Love. — The  boy-love  of  ancient  Greece  is  of 
the  greatest  historical  significance.  And,  in  our  opinion,  in  the 
development  and  training  of  the  Greeks,  even  during  its  period 
of  greatest  prevalence,  this  vice  could  never  have  played  so 
important  a  role,  even  though,  as  with  other  people,  it  had  been 
manifested  only  in  coarse  sensual  enjoyment.  The  idealizing 
faculty  of  the  Greeks  was  capable  of  ennobling  a  phenomenon 
which  had  its  origin  in  common  sensuality,  and  of  transforming 

1  Genesis,  xix,  4;  Levit.,  xviii,  2;  xxix,  13. 

3  Sext.  Empiric.,  P.  H.  i,  152. 

*  Aristot.,  Pal.,  ii,  6 ;  and  Diodor.  (v,  32).     .    .     .    "in  spite  of  the  great  beauty  of 
their  women." 

4  Sext  Empiric.,  P.  H.  iii,  199.     Described  by  the  author  only  as  "rumors." 
6  Genesis,  xix,  4. 

"Athen.,xii,  517e. 

1  ^Eschylus,  Trilogy,  p.  356. 

*  Athenaus,  Deipnosoph,  p.  602. 
*7Wd.,lib.  xii,  p.  5l7etseq. 

"Dionyeius  Helicarn.  Exc.,  p.  2336,  and  Valer.  Max.,  lib.  vi,  1,  9. 

11  Juven.,  ii,  44a. 

"  Comp.  Sueton,  Nero,  28,  29  ;  Dio,  Cassius,  Juvenal,  Tacitus,  and  others. 


CONTRARY    SEXUAL   FEELING    AMONG   THE    ANCIENTS.          131 

it  into  an  incentive  to  progress  both  in  the  individual  and  the 
masses,  and  to-day  it  stands  unique  in  the  history  of  that 
people.  Like  the  idealized  worship  of  Venus,  uranism  took  on 
a  spiritual  form;  in  Athens  "pederasty"  became  " pedophily" 
The  reckless  violation  of  boys  and  honorable  boy-love  are  to 
be  strictly  distinguished  from  each  other  in  judging  the  male 
relations  which  existed  in  ancient  Greece.  Pederasty  was  not 
approved  by  the  Greeks ;  on  the  contrary,  originally,  in  Athens 
and  Sparta,  it  was  punished  with  dishonor,  exile,  and  death.1 

Still,  the  basis  of  the  relations  between  youths  and  men 
remained  sensual.  Spiritual  communion,  pleasure  in  physical 
beauty,  affection  more  intense  than  pure  friendship,  and  close 
ties  of  fraternity  (associations),  though  sensual  enjoyment  could 
never  be  more  than  that  of  the  eyes,  were  the  original  features 
of  pedophily.  Nowhere  do  we  find  such  a  purification  and 
idealization  of  this  institution  in  education,  philosophy,  poetry, 
and  art  as  among  the  Greeks ;  nowhere  a  similar  respect  for  it 
on  the  part  of  the  State  and  laws.  Too,  this  fact  is  not  altered 
by  the  circumstance  that  the  limits  of  moderation — the  bridling 
of  sensual  passion — set  by  individuals  were  also  exceeded, — a 
condition  which  led  to  legal  regulation  of  these  relations. 

Above  all,  according  to  historical  evidence,  pederasty,  as 
long  as  it  maintained  its  independent  position,  seems  to  have 
been  regarded  as  a  disgraceful  vice  by  the  Greeks  (Sparta  and 
Athens).2  On  the  other  hand,  it  cannot  be  denied  that,  in  some 
Grecian  States,  boy-love  never  became  elevated  above  the  state 
of  unnatural  vice ;  for  example,  in  Crete  (kidnapping  of  boys 
and  pederasty),  Elis,  and  Bceotia,3  and  also  in  Phocis,  Thessaly, 
Lesbos,  Chalcis  (%a%,xibi%£Lv  —  naibspaarelv),  etc.4  But  in  the 
Ionic  cities  boy-love  was  absolutely  forbidden.5 

From  the  way  in  which  boy-love  first  manifested  itself  in 
Athens  and  Sparta, — when  it  was  most  intimately  connected, 

1  Comp.  Realencyclopadie  von  Ersch  und  Gruber,  "Paderastie,"  von  Meier,  who 
adduces  abundant  evidence  of  this. 

3  Comp.  Rosenbaum,  loc  tit.,  p.  196. 

* "  Bootische  Knabenliebe "  was,  according  to  Plato,  Xenophon,  and  Cicero,  an 
equivalent  of  violation  of  boys.  Comp.  Ersch  and  Gruber,  loc.  cit. 

4  Comp.  Theopomp.  ap.  Athens,  605a. 
'  Plato,  Symposium,  182b. 


132  SEXUAL    PAFLESTHESIA. 

during  the  golden  age  of  Greece,  with  the  greatest  works  of  art 
and  science,  and  that  without  endangering  in  any  way  mascu- 
line strength  and  activity  displayed  in  numerous  wars  and  in  the 
games, — it  is  clear  that  this  was  not  yet  a  degenerative  trans- 
formation of  the  man  into  a  woman  (homo-sexuality)  upon  the 
basis  of  neuropathic  disposition,  even  though  sensual  passion, 
frequently  enough,  may  have  surpassed  the  bounds  of  morality 
and  law.  Rather,  the  conditions  of  Greece  give  evidence  that 
there,  as  everywhere,  effemination  was  the  direct  result  of 
pederasty.  During  the  golden  age  of  Athens  pederasty  and 
homo-sexuality  were  already  quite  well  known  and  wide-spread  ; 
during  the  period  of  decadence  and  political  dependence  of 
Greece,  pedophily  lost  its  significance  and  male-love  was  known 
only  in  its  vicious  form.  The  vice  of  male  prostitution  was 
surpassed  only  by  that  of  females  during  the  period  of  decay. 

Many  authors,  Moll  among  them,  express  the  opinion  that 
the  prevalence  of  male-love  is  in  inverse  proportion  to  the  esteem 
in  which  woman  is  held ;  and  numerous  examples  in  support 
of  this  view  may  be  cited  from  the  history  of  Asiatic  peoples. 
It  is  certain  that  this  factor  played  an  important  part  in  the 
peculiar  development  of  Greek  boy-love.  The  isolation  of  the 
women ;  their  exclusion  from  the  benefits  of  education  and 
interest  in  the  welfare  of  the  nation,  and  from  participation  in 
the  later  education  of  children  ;  the  limitation  of  their  activities 
to  the  simplest  household  duties  ;  and  their  exclusion  from  the 
influence  of  improving  and  elevating  social  intercourse,  rendered 
them  incapable  of  taking  part  in  the  intellectual  life  of  the 
men.  The  education  of  boys  lay  in  the  hands  of  the  State ; 
the  relation  between  teacher  and  pupil  necessarily  took  the  place 
of  paternal  influence ;  the  lover  was  the  second  father  of  the 
beloved. 

Pedophily  reached  its  highest  perfection  where  gymnastics 
was  most  assiduously  cultivated  in  the  gymnasia  and  palesta.1 
The  sight  of  the  nude  beauty  of  the  youthful  body  in  the  high- 
est state  of  strength  and  activity  gave  pleasure  to  the  artistic 
sense  of  the  Greeks  and  affected  sensuality.  This  feeling  was 

1  Plato,  Legg,  i,  636b. 


CONTRARY   SEXUAL   FEELING   AMONG   THE    ANCIENTS.         133 

deepened  by  the  intellectual  element  which  was  fostered  by  edu- 
cation. .  Each  lover  necessarily  became  an  example  and  guide 
for  the  beloved  one  in  all  that  was  beautiful  and  good.  In 
Athens,  the  seat  of  philosophical  boy-love,  there  were  no  public 
educational  institutions,  and  all  scientific  and  professional  edu- 
cation was  given  by  some  approved  elderly  man  to  youths  who 
became  attached  to  him.  This  relation  was  brought  about  solely 
by  inclination  ;  for  no  honorarium  was  offered  for  such  instruc- 
tion1;  and  it  took  the  place  of  our  higher  education.  Finally, 
the  necessity  for  the  exercise  of  political  influence  by  means  of 
fraternities  (associations)  favored  the  development  of  boy-love. 
Indeed,  in  Sparta  the  members  of  the  royal  families  were  the 
beloved  in  boyhood  and  lovers  when  matured.  In  a  sensual 
sense,  the  restraint  between  lovers  was  compared  witli  that 
between  parents  and  children,  or  between  children  of  the  same 
family.  In  Sparta,  for  example,  the  lover  represented2  the  be- 
loved in  the  popular  assemblies,  and  kept  by  his  side  in  battle ; 
and  there  were  instances  of  faithfulness  unto  death.  The 
influence  of  the  lover,  in  its  effect  upon  the  development  of 
manly  virtue  in  the  beloved,  was  so  great  that  not  infrequently 
the  lover  was  punished  for  the  beloved.  The  mixture  of  a 
sexual  element  in  these  relations,  originally  so  pure,  induced  a 
warmth  of  feeling  which  otherwise  exists  duly  between  man 
and  woman  ;  the  efforts  to  win  favor  led  to  the  most  violent 
jealousy ;  the  delicate  playfulness  and  the  ways  in  which  the 
lover  expressed  his  feeling  call  to  mind  contrary  sexual  feeling, 
— spending  the  night  at  the  door  of  the  beloved ;  serenades ; 
carving  the  beloved  name  on  walls,  on  trees,  and  doors  ;3  swing- 
ing garlands  on  the  house  of  the  beloved;  presents  of  vases4 
on  which  were  inscribed  confessions  of  love. 

This  coquettish  playfulness  also  expressed  itself  in  poetry. 
The  lyric  poets,  Pindar,  Alceus,  Anacreon,  and  Ibycus  sang  of 
boy-love.  Epic,  elegiac,  and  bucolic  poetry,  and,  later,  the 
drama,  each  contributed  its  share.  Even  a  woman,  the  Syci- 

1  Comp.  Ersch  and  Gruber,  Realencyclopadie,  "  Paderastie,"  von  Meier,  p.  837. 

3  Plutarch,  De  educ.  puer.,  14. 

"Plato,  Symposium,  184a;  and  Xenophon,  Hiers.,  1,  35. 

4  Boetig,  Sabin.,  i,  49,  7050. 


134  SEXUAL    PARjESTHESIA. 

onian  poetess,  Praxilla,1  sang  of  male-love.  The  Greek  gods 
and  heroes  glorified  the  fraternity  of  arms  and  the  relations  of 
the  lovers. 

Of  the  more  familiar  examples  may  be  mentioned  Zeus 
and  Ganymede,  Pelops  and  Poseidon,  Achilles  and  Patrocles, 
Orestes  and  Pylades,  Heracles  and  Hylas,  Apollo  and  Admet ; 
Adonis  is  beloved  by  Dionysius,  Theseus  by  Minas,  etc. 

The  most  illustrious  men  Greece  produced  stood  in  the 
closest  relation  to  the  peculiar  institution  of  boy-love.  It  will 
suffice  here  to  allude  to  the  following  examples,  which  by  their 
influence  attained  historical  significance,  and,  in  a  measure, 
became  the  basis  of  political  movements. 

Solon2  is  reputed  to  have  loved  Pisistratus;  Pisistratus,3 
Charmus;  Charmus,  Hippias,  etc.  The  love  of  Harmodius4and 
Aristogeiton  became  the  cause  of  the  liberation  of  Athens  from 
the  tyrants  (Aristogeiton's  jealousy  of  the  tyrant  Hippias). 

Aristides  and  Themistocles  both  sought  the  favor  of  Ste- 
sileos,  which  became  the  cause  of  their  rivalry.  The  three 
great  tragic  poets,  ^Escylus,  Sophocles,  and  Euripides,  glorified 
boy-love  both  in  poetry  and  life,  as  did  Agathon  and  Aristopha- 
nes. The  greatest  sculptor  of  Athens,  Phidias,  loved  Agora- 
critus  and  Pautarches.6 

Of  the  famous  statesmen  who  were  devotees  of  boy-love, 
there  were  Alcibiades,  ^Eschines,  Timarch,  Demosthenes,  and 
Demetrius.  Likewise,  the  most  celebrated  philosophers  were 
given  to  it, — Socrates,  Parmenides,6  Plato,  Dion,  Phedrus, 
Alexis.  Zeno,7  the  founder  of  the  Stoa,  seldom  or  never  had 
intercourse  with  women,  but  only  with  beautiful  boys,  which 
must  be  regarded  as  a  sign  of  beginning  homo-sexuality.  The 
Stoics  were  often  reproached  with  having  followed  the  example 
of  their  founder  with  only  too  much  zeal. 

1  Athenaus,  xiii,  p.  603a. 

3  Plutarch,  Erotic,  5,  and  Sol.,  i. 

1  Plato,  Symposium,  ix,  p.  182b. 

'Plutarch,  Aristides,  2  ;  Themistocles,  3. 

1  Pausanias,  ix,  34 ;  i  and  v,  11 ;  iii  and  vi,  lOb. 

'  Plato,  Parmenides.  52u.    Diogenes,  LaSrt,  ix,  25. 

1  Athenaus,  563c. 


CONTRARY   SEXUAL   FEELING   AMONG   THE   ANCIENTS.         135 

Impure  Male- Love  in  Greece. — The  fact  that  Socrates1 
sought  to  elevate  the  wide-spread  relation  of  pedophily  and  give 
it  a  moral  direction  illustrates  clearly  enough  the  frequent 
occurrence  of  pederasty  during  his  time.  On  the  contrary, 
in  his  philosophy,  Zeno2  goes  so  far  as  to  place  unnatural 
intercourse  of  boys  and  men  on  a  level  with  natural  sexual 
congress.  It  is  no  wonder  that  the  adherents  of  immoral  boy- 
love  have  ever  sought  to  cover  themselves  with  the  mantle  of 
Socratic  and  Stoic  philosophy.  This  is  not  the  place  to  deter- 
mine to  what  extent,  in  individual  cases,  pedophily  was  abused 
for  sexual  purposes.  There  was  no  want,  in  comedy  (Aristoph- 
anes) and  in  literary  productions,  of  attacks,  denunciations, 
formal  complaints,  and  punishments  directed  against  this  form 
of  indulgence ;  the  whole  of  Greek  literature  gives  clear  evi- 
dence that,  during  the  period  of  highest  morality,  immoral 
boy-love  was  regarded  as  a  disgrace. 

Solon  showed  his  respect  for  boy-love3  by  the  enactment 
of  a  law  which  denied  it  to  slaves,  and  thus  elevated  it  to  be  a 
prerogative  only  of  free  individuals.  If,  however,  an  Attic  citi- 
zen voluntarily  prostituted  his  person4  for  gain,  the  law  punished 
him  with  life-long  loss  of  all  the  rights  of  citizenship.  Still 
severer  punishments  were  inflicted  upon  those  who  committed 
the  crime  with  minors.  Between  sunset  and  sunrise  the  gram- 
mar- and  wrestling-  schools  were  closed  by  law,5  in  order  that, 
during  the  darkness,  there  might  be  no  opportunity  for  the 
seduction  of  boys.  Likewise,  the  children-festivals  and  attend- 
ance at  the  gymnasia  were  carefully  regulated.  On  the  other 
hand,  barber-shops,  ointment-shops,  drug-stores,  and  bath-houses 
seem  to  have  been  the  places  of  show  where  men  in  love 
dallied.  The  good  old  morality  and  education  gradually  gave 
place  to  effeminate  practices,  and  male-love,  previously  regarded 
only  as  an  error  and  indulged  in  secret,  became  more  and  more 
shamelessly  prevalent.  With  this  process  of  development,  in 
ancient  Greece,  the  history  of  contrary  sexual  feeling  reached 
the  stage  where,  on  the  foundation  of  base  immorality  and 

1  Plato,  Symposium.  '  Plato,  Symposium,  182b. 

*  Athen.,  563c.  *  ^Eschines,  contra  Tim.  fin.,  p.  44. 

1  ^Eschines,  op.  cit,,  p.  36. 


136  SEXUAL    PAR^ESTHESIA. 

previous  pederasty,  homo-sexuality  and  effemination  began  to 
manifest  themselves,  owing  to  attempts  to  approach  the  required 
female  sexual  role. 

Youths,  as  Aristophanes1  says,  sold  their  bodies  for  money, 
and  boy-love  became  a  means  of  livelihood.  The  pathici  began 
to  attract  the  attention  of  lovers  by  means  of  low,  coquettish  arts, 
and  did  not  despise  those  of  the  toilet, — m/UUjTM^fcrSai.  If 
possible,  they  deprived  their  persons  of  every  mark  of  mascu- 
linity ;  they  gave  themselves  to  vile  uses  in  secluded  spots,  in 
private  houses,  on  the  walls,  etc.  Handsome  young  slaves  were 
forced 2  to  yield  their  bodies  to  their  masters  for  gain,  and  live 
in  actual  houses  of  prostitution.  The  extent  to  which  the  puer 
venalis  was  characterized  by  his  external  appearance  is  shown 
by  the  Greek  proverb :  "  It  is  easier  to  take  five  elephants 
under  the  arm  than  to  conceal  a  pathicus."3  Then  male  pros- 
titution became'a  trade 4  that  was  taxed.  The  Senate  of  the  Five 
Hundred  farmed  out  this  tax  yearly  to  a  man  who  collected  it. 
Thus  we  see  how  the  originally  pure  boy-love  found  its  end  in 
prostitution  and  effemination. 

0>7/leia  VOVGO$. — The  following  facts  present  us  with  the 
important  proof,  from  historical  sources,  that  the  theory  of  con- 
trary sexual  instinct,  as  to-day  set  forth  by  von  Krafft-Ebing,  for 
example,  was  known  to  the  ancients  in  all  its  essential  points, 
both  pathological  and  moral.  Indeed,  Rosen  baum,5  by  a  care- 
ful investigation  of  various  statements  by  credible  authors,  has 
shown  that,  for  designating  this  class  of  men,  the  Greeks  had  a 
term  which  in  meaning  is  identical  with  what  Westphal  named 
"  contrary  sexual  feeling."  Herodotus  first  applied  this  term  to 
the  Scythians,  who  learned  pederasty  in  Asia  (Ascalon  in  Syria), 
returned  as  pathici,  and  widely  developed  the  vice  in  their  native 
land.  He  says  :  "  The  goddess  Venus  Urania  let  Sfaziav  vovcov 
fall  upon  them, — i.e.,  the  passion  or  disease  which  transformed 
them  into  women"  Among  a  people  like  the  Greeks,  whose 
intellectual  development  was  of  the  highest  order,  male  sexual 
intercourse  was  practiced  only  by  a  certain  percentage  of  the 

1  Aristophanes,  Plut.,  153,  159.  '  Lucian,  adv.  Indoct.,  §  23. 

a  Diog.,  LaBrt.,  vi,  54.  *  ^Eschines,  p.  134  etseq. 

*  Rosenbaum,  loc.  cit.,  p.  177  d  seq. 


CONTRARY    SEXUAL   FEELING    AMONG    THE    ANCIENTS.          137 

people ;  on  the  other  hand,  with  a  race  of  small  resistive  force, 
like  the  Scythians,  whose  sexual  character  was  never  markedly 
developed,  the  whole  transformation  to  the  feminine  type,  both 
mentally  and  physically,  took  place  much  more  readily  in  gen- 
eral, and  thus  became  more  striking  to  the  foreign  observer. 

Spontaneous  Origin  and  Cultivation  of  the  Feminine  Type 
in  the  Male. — Hippocrates  referred  this  Scythian  disease  to  con- 
stant riding,  which  induced  frequent  pollutions.  Too,  it  was 
thought  that  nomadic  life  contributed  to  this,  for  the  Scythians 
were  not  accompanied  by  their  wives  on  their  expeditions.1 
Many  authors,  Hammond2  included,  are  of  the  opinion  that 
excessive  riding  induces  atrophy  of  the  testes  and  consequent  im- 
potence. Those  affected  with  the  disease  lost  the  physical  and 
mental  peculiarities  of  the  male  sex ;  impotence  occurred,  the 
beard  disappeared,  and  the  penis  and  testes  atrophied.  "  Finally, 
the  mind  becomes  so  much  affected  that  these  individuals  look 
upon  themselves  as  women,  dress  like  women,  and  assume  the 
habits  and  pursuits  of  the  female  sex  "  (Hammond). 

Too,  among  the  modern  descendants  of  the  Scythians,  the 
inhabitants  of  the  Caucasus,  impotence  is  said  to  be  of  frequent 
occurrence.  Constant  compression  of  the  vesiculse  seminales 
and  the  prostate  induces  frequent  pollutions,  irritable  weakness, 
and,  as  a  final  consequence,  impotence.3 

Two  cases  of  Hammond's4  are  classical  examples  of  the 
possibility  of  artificial  transformation  of  a  man  into  a  woman ; 
and  they  are  briefly  given  here  because  they  are  of  fundamental 
importance  in  the  consideration  of  the  origin  of  contrary  sexual 
instinct.  According  to  Hammond's  report,  among  the  Pueblo 
Indians  of  New  Mexico  it  is  customary  to  induce  impotence  in 
one  native  in  each  village  and  use  him  for  pederastic  purposes. 
This  person  is  called  a  mujerado  (mujeriego  =  changed  into  a 
woman).  The  first  case  was  that  of  an  individual,  aged  35, 
dressed  as  a  woman ;  the  breasts  were  unusally  developed  and 
looked  like  those  of  a  pregnant  woman.  He  told  Hammond 

1  Sprengel,  Apologie  des  Hippocrates,  Leipzig,  1793,  Part  II,  p.  610. 

3  Hammond,  loc.  cit.,  p.  106. 

1  Lallemand,  Des  pertes  sdminales,  Paris,  1836,  Part  I,  p.  581. 

4  Hammond,  loc.  cit.,  p.  Ill  et  seq. 


138  SEXUAL    PAR^ESTHESIA. 

that  he  had  nursed  several  children  whose  mothers  had  died, 
and  that  he  was  able  to  furnish  them  much  milk  from  his 
breasts.  No  pubic  hair;  penis  much  reduced  in  size;  the 
scrotum  contained  the  remnants  of  testicles ;  slight  varicocele. 
He  had  been  a  mnjerado  for  seven  years ;  but,  up  to  the  begin- 
ning of  that  period,  he  had  possessed  all  the  sexual  attributes 
of  masculinity.  At  first  his  testicles  became  smaller,  and  with 
their  atrophy  he  lost  sexual  desire  and  all  inclination  for  mascu- 
line pursuits,  and,  therefore,  sought  female  society.  At  first 
his  penis  retained  its  normal  size.  After  the  loss  of  erectile 
power  the  member  soon  became  atrophic.  He  said  that  before 
he  became  a  mujerado  he  had  a  large  penis  and  testicles  of  the 
size  of  eggs, — a  statement  confirmed  by  his  companion.  His 
voice  was  high  and  thin. 

The  second  mujerado  examined  by  Hammond  had  atro- 
phied penis  and  testicles,  "  which  apparently  consisted  of  con- 
nective tissue."  Pubic  region  free  from  hair ;  breasts  not  espe- 
cially developed ;  limbs  full  and  round  ;  hair  only  on  the  head  ; 
voice  high  and  weak.  His  nude  appearance  was  more  that  of 
a  woman  than  that  of  a  man.  He  was  36  or  37  years  old. 

As  in  the  religious  orgies  of  the  ancients  (priests  of  Cybele), 
among  those  of  this  race  of  Indians  the  mujerado  is  indispens- 
able for  the  performance  of  the  passive  role  in  pederastic  prac- 
tices. For  the  production  of  a  mujerado  usually  one  of  the 
most  powerful  men  is  chosen,  and  masturbation  is  practiced  on 
him  many  times  daily.  At  the  same  time  he  must  ride  con- 
stantly, and  that  without  a  saddle.  Irritable  weakness  and 
diminution  of  the  nutrition  of  the  genitals  set  in.  Then,  in 
spite  of  orgasm,  ejaculation  becomes  impossible,  and  finally  it 
is  no  longer  possible  to  induce  orgasm.  Then  atrophic  shrink- 
ing of  the  penis  and  testicles  occurs.  Simultaneously  the  man's 
courage  disappears ;  he  becomes  timorous ;  all  his  influence 
and  responsibility  are  removed,  and  he  bears  himself  like  the 
women  of  his  race.  Besides  this,  he  tries  to  divest  himself  of 
all  masculine  characteristics.. 

The  victim  of  the  vovdog  $>?/leia,  the  Scythian  disease, 
differs  from  the  mujerado  only  in  that  what  took  place  in  the 


CONTRARY    SEXUAL   FEELING    AMONG   THE    ANCIENTS.          139 

former  as  the  accidental  result  of  certain  customs  and  habits 
was  artificially  brought  about  in  the  latter  for  a  distinct  purpose. 
After  this  diversion,  important  for  an  understanding  of  contrary 
sexual  instinct,  we  may  return  to  the  ancients. 

Views  of  Some  Ancient  Writers  Concerning  the  Pathicus. 
— The  historical  facts  of  the  development  of  pederasty  among 
the  Greeks,  as  among  the  Scythians,  confirm  our  view,  previously 
expressed,  that  its  artificial  introduction  among  them,  and  the 
forcible  performance  of  pederasty  on  boys,  form  the  origin  of 
contrary  sexual  instinct  and  effemination;  and  that  then,  through 
its  effects,  seriously  injure  the  manly  virtues  of  the  people, — a 
process  appropriately  called  "  eviration."  The  transformation 
of  the  masculine  type  into  the  feminine,  as  a  result  of  pederasty, 
was  commonly  looked  upon  as  the  revenge  of  outraged  Venus.1 

It  was  known  to  the  ancients  that  the  vice  of  pederasts  was 
capable  of  transmission  hereditarily  to  the  members  of  a  family 
in  the  form  of  disposition, — a  confirmation  of  von  Krafft-Ebing's 
theory  of  heredity.  However,  the  same  form  of  perversion  did 
not  necessarily  appear.  The  case  of  Heliades,2  who  had  been 
punished  by  Venus  in  the  manner  mentioned,  had  this  reputa- 
tion. Thus  the  orator  Lysias3  says  of  the  family  of  Alcibiades : 
"  The  majority  of  its  members  had  been  prostitutes."  Indeed, 
there  was  even  a  view  that  the  pathici  might  be  born  with  a 
predisposition  to  the  vice, — an  opinion  which  Parmenides4  (509) 
expressed.  While  the  author  mentioned  looked  upon  the  basis 
of  the  disorder  as  mental,  other  writers,  as  Aristotle,5  regarded 
the  vice  as  a  disease  of  the  rectum.  According  to  Aristotle,  the 
seminal  vessels  conveyed  the  semen  not  to  the  rectum,  but  to  the 
anus,  and  there  excited  pleasure  and  libido.  Those  affected  in 
this  way  were,  in  his  opinion,  congenital  pathici,  from  whom  he 
distinguished  those  produced  by  habit  (jtefyvxoreg  and  E$  e&ov$). 
Here  we  see  the  theory  of  Mantegazza  foreshadowed,  who  looks 
upon  the  cause  of  a  certain  form  of  contrary  sexual  instinct  as 

1  Euripides,  Hippolyt,  5. 

'  Tragedy,  Hippolyt,  124  ;  and  Lucian,  Amores,  c,  2. 

'  Lysias,  Orat.  contra  Alcibiad.,  i,  p.  550. 

'  Caelius  Aurelianus,  de  morb.  acut.  et  chron.,  lib.  vii. 

'  Aristotle,  Problem  iv,  26. 


140  SEXUAL    PARyESTHESIA. 

an  abnormal  distribution  of  nerves  (to  the  rectum).  Statements 
concerning  the  physiognomy  and  other  marks  of  androgynes  and 
pederasts  are  numerous ;  which,  aside  from  the  external  ap- 
pearances given  them  by  the  race  and  the  customs  of  the  times, 
in  all  essential  features  are  comparable  with  those  peculiar  to 
the  sexual  perverts  of  our  day. 

Polemon1  calls  attention  to  the  enticing,  lustful  glance  of 
the  androgyn,  and  says :  "  The  hips  are  in  constant  motion. 
He  speaks  in  a  voice  that  is  high  and  shrill,  forced  and 
tremulous." 

Dio  Chrysostom2  thought  he  could  detect  pederasts  by  their 
sneeze.  He  says :  "  Thus  sneezing  revealed  a  man's  real  char- 
acter, and  in  spite  of  all  else  would  betray  him."  Rosenbaum 
thinks  that  during  the  act  of  sneezing  the  pederast  attempted  to 
control  the  sphincter  ani,  since  it  was  weakened  or  destroyed, 
and  could  no  longer  perform  its  function.  "  Even  with  a  normal 
sphincter  it  is  often  hardly  possible,  during  the  act  of  sneezing, 
to  restrain  the  expulsion  of  gas  or  even  fluid  faeces."3 

Lucian  satirizes  the  customs  and  laws  of  the  pederasts ; 
"  how  they  care  for  their  persons,  and  pull  out  their  hair ;  how 
pederasty  is  practiced,  passively  and  actively  " ;  their  features, 
gait,  voice ;  the  bowed  head ;  the  powder,  mastic,  paint,  with 
which  they  adorned  themselves,  etc. 

According  to  Martial,4  "  these  male  prostitutes  had  their 
beards  shaved  as  closely  as  possible,  and  the  hair  removed  not 
only  from  about  the  anus,  but  from  the  whole  body  as  well,  in 
order  to  simulate  the  female  person."  They  dressed  entirely 
like  women. 

One  of  the  most  noted  pederasts  of  Athens  was  Cleisthenes. 
Aristophanes  made  him  the  object  of  his  satire.  Later  his  name 
became  a  designation  for  pederasts. 

According  to  the  evidence  adduced  by  Rosenbaum,5  out- 
raged nature  revenged  herself  on  the  pathicus  by  assisting  him 

'Polemon,  Physiognom.,  lib.  ii,  9,  1,  c,  p.  290. 

3  Dio  Chrysostomus,  Tarsica,  i,  p.  410. 

1  Clemens  Alexander,  Paedag.,  lib.  ii,  c,  7. 

*  Martial,  lib.  vii,  epigram,  57. 

*  Rosenbaum,  loc.  cit.,p.  179. 


CONTRARY   SEXUAL   FEELING    AMONG   THE   ANCIENTS.         141 

in  his  efforts.  "  Through  distension  of  the  anus  the  nates  grow 
broader  below,  the  intermediate  space  wider,  so  that  the  hips 
assume  more  the  form  of  those  of  a  woman ;  and  the  pelvis 
itself  seems  to  widen.  The  thighs  change  their  direction  and 
the  knees  turn  inward  more  and  more ;  in  short,  the  whole 
inferior  half  of  the  body  takes  on  the  feminine  type.  The 
mind  follows  the  body ;  the  character  becomes  feminine.  The 
pathicus  detests  coitus  with  women,  and  does  not  marry  as  long 
as  he  can  satisfy  his  lust.  When  increasing  years  deny  him 
the  ability  to  satisfy  his  desires,  nature  at  last  has  denied  him 
the  power  of  procreation ;  the  genitals  refuse  to  perform  their 
functions  "  (shrinkage  from  disuse,  and  paralytic  impotence). 

But  psychical  hermaphroditism — a  transitional  stage  in  the 
process  of  effemination — was  also  known  to  the  ancients.  Al- 
cibiades  held  intercourse  with  both  sexes ;  Dionysius  practiced 
normal  coitus  and  passive  pederasty.1  Therefore,  the  latter  was 
called  dvfy&ywo$.  While  for  the  passive  party  in  pederasty,  the 
pathicus,  there  was  an  inclination  to  find  an  excuse  in  regard- 
ing the  phenomenon  as  a  pathological  result  of  artificial  culti- 
vation,— as  a  person  suffering  with  a  voao$  (disease),  dvdv&pta, — 
for  the  active  party  there  was  no  excuse.  He  was  regarded  as  a 
debauchee  "  who  destroyed  the  virtues  of  manhood  most  useful 
in  war  and  peace ;  who  in  their  place  substituted  in  the  mind 
the  vovaog  Sfaeia  and  created  androgynes ;  and  who,  destroying 
manly  virtues,  and  giving  them  the  peculiarities  and  character- 
istics of  an  object  of  love,  injured  the  lover  in  the  most  precious 
things  of  life, — body,  soul,  and  possessions." 2 

The  passion  to  become  a  woman — evidenced  by  all  author- 
ities— is  everywhere  manifest  later  in  history  than  the  practice 
of  pederastic  acts  with  boys  and  men,  which,  as  a  rule,  are  at 
first  enforced.  The  spread  of  this  perverse  activity  of  the 
sexual  instinct  may  therefore  be  regarded  as  the  cause  of  the 
congenital  disposition  to  play  the  role  of  a  woman  and  become 
a  pathicus.  For  the  androgynes  (psychical  hermaphrodites) 
allow  themselves  to  be  used  as  women,  and,  besides,  beget 

1  Lucian,  De  dea  Syra,  c.  xvi. 

1  Philo,  De  vita  contemplativa,  p.  480,  cited  by  Rosenbaum,  loc.  cit. 


142  SEXUAL    PARJSSTHESIA. 

children ;  they  do  not,  like  the  pathicus,  need  to  suffer  with 
vovao$  3>7/leia,  but  they  may,  for  the  sake  of  gain,  prostitute 
themselves. 

One  of  the  best  and  most  complete  confirmations  of  the 
correctness  of  the  foregoing  views  which  throws  a  clear  light 
upon  the  etiology  of  contrary  sexual  instinct  among  the  masses 
is  Philo's  description  of  the  unrestrained  lust  and  vice  of  the 
Sodomites.  * "  Not  only  did  those  taken  with  a  passion  for 
women  dishonor  the  marriage-bed  of  others,  but  men  even 
approached  men ;  pederasts  of  the  same  sex  were  not  ashamed 
to  consort  with  the  pathicus ;  expending  useless  seed,  they 
despised  the  begetting  of  children.  Disgrace  was  without  effect 
upon  those  controlled  by  so  powerful  a  passion.  Later,  those 
born  as  men  accustomed  themselves  to  play  the  role  of  women, 
and  took  to  themselves  the  vovaog  3>?/leia  as  a  vice  against  which 
it  was  vain  to  struggle.  For  not  only  the  body,  as  a  result  of 
feminine  conduct  and  manner  of  life,  became  feminine,  but  the 
mind  as  well  was  deprived  of  all  male  characteristics,  and  they 
destroyed,  as  far  as  they  could,  all  masculinity."  In  another 
place  Philo l  speaks  of  those  to  whom  the  law-giver  refused  per- 
mission to  frequent  holy  precincts :  "  He  kept  all  unworthy 
persons  from  visiting  the  temples ;  he  began  with  the  andro- 
gynes,— -those  who  were  affected  with  the  vovao$  Sfaeia ;  who 
distorted  nature's  order  and  assumed  the  desires  and  appearance 
of  lascivious  women.  He  expelled  those  whose  testicles  were 
concealed  and  whose  genitals  had  been  removed  with  the 
thought  of  preserving  a  youthful  appearance  arid  changing  the 
masculine  to  the  feminine  type,"  etc. 

R6sume  of  Conclusions. — Pederasty,  as  the  foregoing  cita- 
tions show,  had  its  origin  in  Asia  ;  it  was  adopted  by  the  Greeks 
and  changed  into  the  form  of  ideal  pedophily.  This  peculiar 
institution  exerted  great  influence  in  the  development  of  the 
Greek  nation,  on  politics,  art,  and  science.  But,  as  soon  as 
pedophily  degenerated  into  violation  of  boys,  the  results  of  the 
vice  were  not  wanting.  It  then  was  looked  upon  as  the  curse 
of  Venus  for  a  sin  against  nature.  Thus  there  arose  the  class 

» Philo,  De  sacrificautibus,  p.  261. 


CONTRARY    SEXUAL   FEELING    AMONG    THE    ANCIENTS.          143 

called  pathici.  These  individuals  correspond  with  our  ideas  of 
those  affected  with  contrary  sexuality  in  our  day.  But  the 
necessary  artificial  role  of  woman  caused  destruction  of  manly 
virtues.  "  Since  a  man  of  sound  reason  could  not  possibly 
allow  himself  to  be  used  as  a  woman,  when  he  does  so  he  must 
be  suffering  with  a  disease, — a  VOGO$  which  changes  him  to  a 
woman  (Sh^eia)  "  (Rosenbaum). 

Later,  matured  men  became  pathici,  which  was  the  first 
clear  indication  that  this  phenomenon  was  pathological,  and, 
at  the  same  time,  nervous  and  mental  affections  occurred  simul- 
taneously, or  as  its  results  (impotence,  dementia,  etc.).  Still, 
among  the  Greeks  effemination  never  became  general,  as  among 
the  Scythians.  Castration  originated,  as  we  have  seen,  from 
the  desire  of  the  pathicus  to  preserve  the  characteristics  of  youth, 
and,  as  I  surmise,  to  prevent  the  development  of  the  secondary 
sexual  peculiarities  (voice,  beard), — which,  according  to  the  Dar- 
winian theory,  make  their  appearance  at  the  time  of  sexual  ma- 
turity,— that  the  greatest  possible  resemblance  to  woman  might 
be  attained.  Further,  the  foregoing  detailed  account  shows 
that  the  whole  theory  of  contrary  sexuality,  with  reference  to 
cultivation  and  heredity  as  well  as  to  the  forms  in  which  it  man- 
ifests itself, — psychical  hermaphroditism  and  effemination  in  its 
various  degrees, — was  known  to  the  ancients.  Contrary  sexual 
instinct,  however,  historically  considered,  appears  as  the  direct 
result  of  pederasty ;  and  the  latter,  in  the  primary  practice  of 
it,  is  nothing  more  than  a  vice  practiced  on  youth  or  man  (per- 
haps by  force),  instigated  by  immoral  motives.  Only  habitual 
practice  of  pederasty  leads  to  degeneration  and  changes  the 
sexual  character  of  the  passive  party  to  that  of  the  female, — 
i.e.,  it  induces  an  inversion  of  sexual  feeling,  which,  once  de- 
veloped to  a  fixed  peculiarity,  is  in  a  condition  to  exercise  further 
effects  through  heredity. 

During  the  decadence  of  the  Greeks  and  Romans  and  of 
other  nations,  neuropathy  and  increasing  degeneration  gave  the 
broadest  basis  for  the  prevalence  of  all  forms  of  immorality,  and, 
therefore,  during  the  periods  of  moral  decadence  of  the  people, 
contrary  sexual  instinct  appeared  everywhere  in  the  form  of 


144  SEXUAL    PAR^ESTHESIA. 

complete  effemination  and  public  prostitution,  often  in  com- 
bination with  symptoms  of  insanity  (Caesarian  insanity),  and  it 
is  difficult  in  individual  cases  to  determine  to  what  extent  this 
perversion  of  the  sexual  instinct  represents  the  product  of  the 
practice  of  degenerate  customs  (prostitution)  or  of  m hereditary 
predisposition.  This  difficulty  also  explains  the  views  of  au- 
thorities, by  whom  contrary  sexual  instinct  is  regarded  as  the 
symptom,  as  a  rule,  of  a  degeneration  of  the  central  nervous 
system. 

In  sexual  development,  however,  the  original  course,  as  we 
have  shown,  is  different :  as  a  result  of  moral  contagion  or  other 
external  cause,  a  normal  race  may  come  to  practice  pederasty ; 
this  gives  birth  to  contrary  sexual  instinct,  and  the  latter  then 
leads,  through  transformation  of  character,  to  degeneration  of 
the  individual.  Therefore,  only  secondarily  can  contrary  sexual 
instinct,  on  the  basis  of  hereditary  predisposition  of  the  central 
nervous  system,  become  developed  as  a  symptom  of  this  taint. 


CHAPTER  IX. 

HEREDITY  AND   EDUCATION   IN   THEIR   ETIOLOGICAL 
RELATIONS   TO    SEXUAL   PERVERSIONS. 

The  Importance  of  the  Part  Played  by  Heredity  in  Anom- 
alies of  the  Sexual  Instinct. — Owing  to  the  frequency  of  their 
occurrence  and  the  legal  enactments  concerning  coitus-like  acts 
between  men,  in  the  literature  of  anomalies  of  the  sexual  in- 
stinct contrary  sexual  instinct  takes  the  most  important  place. 
Too,  there  is  hardly  another  error  of  the  sexual  appetite  be- 
sides that  of  sexual  inversion  that  is  so  powerful  in  transforming 
the  whole  personality  and  character.  The  question  concerning 
the  causes  and  origin  of  this  perversion,  as  shown  by  the  opin- 
ions given  in  the  celebrated  case  of  the  Countess  V.,1  is  still 
unsettled ;  and,  in  spite  of  the  valuable  review  of  the  etiology 
which  Moll2  gives  after  a  careful  consideration  of  the  majority 
of  the  authorities,  the  question  still  seems  to  us  to  be  an  open 
one. 

The  more  the  number  of  cases  increases  in  which  perma- 
nent therapeutic  results  have  been  obtained,  the  less  seems,  in 
our  opinion,  the  influence  of  hereditary  disposition  in  the  origin 
of  this  anomaly.  The  discovery  and  exact  estimation  of  the 
hereditary  factor  and  of  the  extraneous  influences  that  have 
had  a  baneful  effect  on  development  form  the  basis  of  diagnosis 
and  prognosis.  As  von  Krafft-Ebing  justly  remarks,  it  might 
be  presumed  a  priori  that  it  would  be  impossible  to  remove  or 
modify  a  congenital  perversion.  Hence  the  hopeless  prospect 
offered  to  such  patients  by  text-books  on  psychiatry,  such  as 
Krapelin's.3  He  says,  "  There  can  be  no  thought  of  treatment 
of  an  anomaly  like  this,  which  has  developed  with  the  develop- 
ment of  the  personality  and  has  its  origin  deep  within  it."  If, 
however,  in  cases  which  are  presumably  due  to  hereditary 
disposition,  a  complete  transformation  of  the  psycho-sexual 

1  Friedreich's  Blatter  f.  ger.  Mert.,  1891,  Heft  1,  pp.  32,  83. 
9  Moll,  loe.  cit.,  p.  156  et  seq. 
'  Psychiatric,  2  Aufl.,  p.  576. 

(145) 


146  SEXUAL    PAR^ESTHESIA. 

character  is  brought  about,  there  can  be  but  two  ways  in 
which  to  explain  it :  either,  in  comparison  with  extraneous 
influences,  the  effect  of  hereditary  disposition  has  been  over- 
estimated, or  it  is  actually  possible  to  compensate  by  suggestion 
the  dire  effect  of  hereditary  factors. 

For  therapeutic  nihilism,  of  course,  the  theory  of  heredity 
is  the  most  convenient,  and  individuals  of  contrary  sexuality, 
who,  in  numerous  instances,  have  no  consciousness  of  their 
abnormality  (contrary  to  Westphal's  idea),  find  in  it  a  very 
welcome  excuse  for  their  peculiarity :  they  believe  that  they  are 
justified  in  obeying  an  impulse  for  the  manifestations  of  which, 
owing  to  its  hereditary  origin,  they  regard  themselves  as  irre- 
sponsible. And  therein  also  lies  the  reason  why  such  persons, 
happy  in  their  peculiarity,  will  know  nothing  of  treatment. 
Usually  it  is  not  the  anomaly  of  their  feeling  that  brings  them 
to  the  physician,  but  fear  of  conflict  with  the  law,  and  sexual 
hyperaesthesia  which  threatens  to  betray  them ;  or  symptoms  of 
progressive  neurasthenia,  which  interfere  with  occupation  and 
daily  life,  are  the  causes  which  lead  them  to  seek  medical  advice. 

Hereditary  Disposition  in  General. — If  the  character  of 
the  child  were  determined  in  the  mother's  womb,  to  continu- 
ously unfold  in  post-natal  life,  then  the  influence  of  education 
would  be  illusory.  To  speak  with  precision,  hereditary  inclina- 
tions are  nothing  but  the  results  of  the  habits  of  our  ancestors 
acquired  through  repeated  and  multiplied  acts, — i.e.,  capitalized 
activity  that  lives  and  constantly  grows  by  its  own  activity. 
This  fact  is  also  demonstrated,  as  we  have  seen  in  the  foregoing 
chapter,  by  the  history  of  the  origin  of  contrary  sexual  instinct. 
Every  individual  benefits  or  injures  his  descendants  through 
the  series  of  acts  which  make  up  his  life,  and  which,  through 
habit,  become  transformed  in  descendants  into  hereditary  dis- 
position. The  mechanism  of  heredity  and  our  intelligence  con- 
tinually exert  a  reciprocal  influence  on  each  other.  Custom, 
through  heredity,  becomes  racial  instinct,  in  so  far  as  in  the 
past  a  repeated  act,  which  at  first  is  to  a  certain  extent  reflex 
in  the  process  of  adaptation  to  surroundings,  may  become  typical 
for  the  future. 


HEREDITY   AND   EDUCATION.  147 

Racial  morality  is  the  condition  of  our  progress  and  self- 
preservation  ;  the  object  of  education  is  to  influence  our  moral 
and  immoral  hereditary  tendencies, — i.e.,  to  seek  to  control  our 
animal  instincts.  The  education  of  centuries  is  fixed  in  the 
present  generation  by  heredity,  and  yet  we  see  the  mighty  power 
of  racial  instinct  continuously  working  atavistically.  Thus,  the 
war-like  tendencies  manifested  in  duels  to-day  are  but  the  natural 
result  of  the  battles  of  our  ancestors.  Still,  every  hereditary 
disposition,  to  become  active,  requires  its  specific  excitant ;  and 
from  this  may  be  estimated  the  enormous  force  which  education 
acquires  in  the  selection  of  the  influences  which  affect  us. 
Every  organism  passes  through  developmental  or  retrograde 
changes  in  accordance  with  the  multitudinous  adaptations  made 
inevitable  by  the  struggle  for  existence.  Physical  peculiarities 
(constitution,  stoutness,  longevity)  are  inheritable,  like  tempera- 
ment, lack  of  power  of  resistance  to  external  influences,  and 
certain  diseases  and  dispositions  to  disease.  However,  within 
the  broad  realm  of  inexorable  law  there  is  still  left  sufficient 
room  for  the  exercise  of  human  influences.  Pseudo-heredity 
depending  upon  the  imitative  tendency  of  children  must  also  be 
taken  into  account.  In  large  measure  inheritance  is  something 
possible,  but  by  no  means  certain.  Defect  in  the  father  may  be 
compensated  by  corresponding  perfection  in  the  mother. 

For  the  most  part,  as  von  Krafft-Ebing  also  allows  in  con- 
trary sexual  instinct,  only  the  disposition  to  disease  is  inherited. 
Whether  and  to  what  extent  it  is  developed  largely  depends 
upon  later  extraneous  influences.  The  theory  of  atavism  makes 
it  probable  that  generations  apparently  free  from  it  still  bore  the 
disposition  undeveloped  arid  transmitted  it.  Of  all  nervous  and 
mental  diseases,  irritable  weakness  of  the  nervous  system  is 
most  frequently  transmitted  as  a  neuropathic  disposition,  and  it 
may  develop  into  neurasthenia,  and  thus  become  the  foundation 
of  nervous  diseases,  according  to  the  kind  and  intensity  of  the 
injurious  influences  of  life.  But,  on  the  other  hand,  a  proper 
mode  of  life  may  do  much  to  prevent  the  development  of  the 
hereditary  disposition,  and  thus,  in  a  measure,  compensate  it. 

Predisposition  and    Patlwgenetic  Excitants. — In  constitu- 


148  SEXUAL    PARJESTHESIA. 

% 

tional  diseases,  as  in  tuberculosis,  only  a  predisposition  to  them 
is  transmitted.  It  is  very  seldom,  even  though  it  be  demon- 
strated, that  tuberculosis  is  directly  congenital.  Thus,  the 
reports  of  Brehmer's  sanatorium  (Wiesbaden,  1889),  gathered 
from  506  cases  of  tuberculosis,  show  that  the  children  of 
tuberculous  parents  are  by  no  means  always  tuberculous,  but, 
on  the  contrary,  the  grandchildren  relatively  often.  As  Dr. 
Krocker1  reports,  Dr.  Sommerbrodt  treated,  in  1885,  a  lady  who 
was  pregnant  for  the  fourth  time,  but  subject  to  progressive 
tuberculosis.  The  first  three  children  had  died  of  more  or  less 
pronounced  tuberculosis.  By  a  rigid  observance  of  all  means 
to  prevent  infection,  not  only  was  there  success  in  saving  the 
life  of  the  fourth  child,  born  in  December,  1886,  and  preventing 
infection,  but  the  same  means  were  successful  in  the  case  of  the 
fifth.  One  child  is  now  3  and  the  other  nearly  4  years  old,  and 
both  are  blooming  and  healthy. 

There  could  be  no  clearer  demonstration  of  the  fact  that 
with  inherited  disposition  to  a  disease  there  must  also  be  the 
specific  pathogenetic  excitant  in  order  to  produce  the  actual 
disease.  The  etiological  factors  of  predisposition  and  exciting 
influence  operate  analogously  in  contrary  sexual  instinct. 

Heredity  and  Exciting  Causes  in  Mental  Diseases. — Like 
the  majority  of  psychoses,  the  heredity  of  contrary  sexual  in- 
stinct presents  the  picture  of  polymorphia.  Only  in  one  case 
(von  Krafft-Ebing)  was  the  father  said  to  be  affected  in  the 
same  way.  As  a  rule,  only  a  neuropathic  disposition,  a  slight 
degree  of  mental  weakness,  or  (according  to  Koch)  psycho- 
pathic inadequacy  is  congenital.  Whether,  on  the  basis  of  this 
hereditary  lack  of  resistive  power,  contrary  sexual  instinct  must 
necessarily  develop  as  the  hereditarily-conditioned  product  seems 
questionable.  Moll2  avoids  the  answer,  when  he  says;  "Why 
in  the  one  case  the  degeneration  expresses  itself  in  epilepsy, 
and  in  the  other  as  contrary  sexual  instinct,  we  are  as  little  able 
to  answer  as  the  question  why,  in  taking  cold,  one  has  catarrh 
and  another  rheumatism." 

*  Comp.  Krocker,  Krankheitsuraachen  und  deren  Bekampfung,  Paetel,  Berlin,  1891. 

*  Loc.  dt.,  p.  162. 


HEREDITY   AND   EDUCATION.  149 

In  his  very  instructive  work  on  direct  heredity,1  E.  Sioli 
differentiates  a  class  of  psychoses  in  which  hereditary  transmis- 
sion is  complete ;  the  same  kind  of  delusions,  like  instinctive 
impulses,  and  a  like  fatal  tendency  to  suicide  are  manifested  at 
a  like  period  of  life,  under  the  influence  of  definite  causes  of  a 
similar  nature.  We  shall  see,  later,  whether  in  literature  cases 
of  contrary  sexual  instinct  are  to  be  found  which  can  be 
assigned  to  this  class. 

More  important  for  us,  however,  is  Sioli's  collection  of 
families  in  which  ancestors  and  descendants  were  aifected  with 
mental  diseases  which  were,  in  descendants,  caused  more  by 
demonstrable  extraneous  influences  the  effect  of  which  could  be 
ascertained,  than  by  inheritance.  Only  new  and  additional  in- 
jurious influences,  or  subsidiary  causes,  induced  a  psychosis  in 
those  descendants  that  showed  no  demonstrable  disposition,  or 
in  those  that  presented  signs  of  degeneration  and  lessened  power 
of  resistance ;  and  the  form  of  the  psychosis  either  corresponded 
with  that  in  ancestors  or  was  transformed.  Such  subsidiary 
causes  are :  puerperium,  puerperal  diseases,  unjust  punishment, 
illegal  pregnancy,  head-injuries,  etc. 

These  exciting  causes  may,  when  sufficiently  intense, 
determine  the  form  of  the  disease ;  still,  the  number  of  such 
psychoses  is  much  smaller  than  those  essentially  determined  by 
heredity. 

The  literature  of  contrary  sexual  instinct,  especially  the 
autobiographies  of  urnings,  leads  us  to  think  that  hereditary 
disposition,  as  a  rule,  has  been  overestimated,  to  the  detriment 
of  exciting  causes.  The  possibility  of  direct  inheritance  of  con- 
trary sexual  instinct,  which,  in  infrequent  cases,  may  develop 
in  spite  of  all  training,  cannot  be  gainsaid,  though  a  convincing 
proof  of  it  has  not  yet  been  given.  On  the  other  hand,  it 
will  be  our  object  to  ascertain  what  influence  exciting  causes, 
especially  of  a  sexual  nature,  may  exert  in  themselves  on  the 
origin  of  this  perversion. 

In  order  to  estimate  fully  and  differentiate  the  causal 
factors  (hereditary  disposition  and  education)  in  the  origin  of 

1  Archiv  far  Psychiatric  u.  Nervenkrankheiten,  Bd.  ivi,  Heft  1-3. 


150  SEXUAL    PAR^STHESIA. 

the  perversions  of  the  sexual  instinct,  it  seems  necessary  to 
consider  man's  normal  sexual  development. 

Physiology  of  the  Development  of  the  Sexual  Instinct. — 
The  procreative  instinct,  corresponding  with  anatomico-physio- 
logical  processes,  develops  relatively  late  in  man. 

The  functional  development  and  growth  of  the  generative 
organs  stand  in  definite  interrelation  to  the  cerebral  cortex, 
where  sensations  and  ideas  (impulses)  arise.  Actual  puberty 
begins,  in  the  female,  at  the  age  of  13 ;  in  the  male,  at  the  age 
of  1 5.  Until  this  time  is  reached  there  is  usually  no  knowledge 
of  sexual  matters.  Under  normal  conditions,  with  the  help  of 
education  and  imitation,  the  mental  type  corresponding  with 
the  sex  is  developed,  which  per  se  does  not  depend  upon  the 
processes  in  the  generative  organs  alone.  In  early  years  the 
individuals  are  sexually  neuter, — a  state  which  Max  Dessoir 
calls  "  undifferentiated  sexual  feeling." 

We  can  neither  assume  that  there  is  innate  knowledge  of 
the  difference  of  the  sexes  nor  the  possibility  of  the  inherit- 
ance of  ideas  at  all.  In  this  sense,  from  a  strict  psychological 
stand-point,  there  is  really  no  "  congenital  contrary  sexual 
instinct." 

Like  all  animals,  man  acquires  the  most  through  practice 
and  experience.  Like  the  sexual  instinct,  the  instinct  for  food, 
in  its  first  blind  expressions,  is  an  impulse  the  purpose  of  which 
is  only  gradually  comprehended,  in  that,  striving  for  fulfillment, 
it  brings  about  external  impressions.  Sense-impressions  are  at 
first  necessary  for  the  expression  of  the  instincts ;  according  to 
Wundt,1  they  alone  bring  about  sensation  and  feeling.  The 
idea  of  the  mother's  breast  is  not  innate  in  the  nursling,  but  an 
ill-defined  sense  of  hunger2  causes  movements  which  finally  bring 
about  the  satisfaction  of  the  need.  "  With  the  first  satisfaction 
comes  an  indistinct  idea  of  external  objects  which  present  them- 
selves in  the  act,  and  thus,  with  the  sense  of  hunger,  at  once 
the  reproduction  of  the  image  of  these  impressions  becomes  asso- 

1  Physiologische  Psychologic,  1887,  p.  231. 

'  Why  speak  of  a  sense  of  hunger  here  at  all  ?  It  cannot  be  a  sense  or  feeling  of  any 
kind.  The  movements  are  purely  reflex,  arising  from  organic  conditions  which  at  first, 
at  this  period  of  life,  can  have  no  relation  to  sense  or  sensibility. — TRANS. 


HEREDITY   AND   EDUCATION.  151 

elated  with  the  desire."  Thus  are  developed  the  simple  in- 
stinctive acts. 

The  development  of  the  sexual  instinct  is  to  be  conceived 
in  the  same  way.  All  ideas  in  relation  to  it  are  the  product  of 
experience,  even  though  the  impulse  belong  to  the  congenital 
instincts.  According  to  Wundt,  only  the  conditions  necessary 
for  the  origin  of  definite  general  sensations,  and  for  the  associa- 
tion of  definite  movements  with  these  sensations,  can  be  con- 
genital. Thus  the  sexual  instinct,  in  its  first  indistinct  expres- 
sions, is  conscious  of  no  definite  purpose,  and,  at  first,  there  are 
only  purposeless  feelings  (physically  produced  by  the  generative 
organs)  and  emotions,  which  are  called  longings  and  impulses, 
and  to  which,  through  sensory  impressions,  the  strengthening 
materials  are  supplied.  The  instinct  induces  movements  which, 
to  a  certain  extent,  are  reflex,  and  leads  to  instinctive  acts.  The 
disposition  to  these  movements  is  congenital ;  it  requires  only 
excitation  by  external  impressions  to  bring  it  to  complete 
development. 

A  pronounced  feeling  in  consciousness  accompanies  the  in- 
stinctive act.  After  organic  sensations  have  excited  the  atten- 
tion of  the  individual,  the  presentiments  are  transformed  into 
clear  ideas  by  sensory  perceptions.  The  sight  of  his  own  person 
or  of  animals  may,  at  first,  satisfy  the  vague  impulses,  and 
contains  elements  from  which  the  imagination  creates  images 
corresponding  with  the  feelings. 

Among  animals  the  instinctive  expressions,  in  accordance 
with  the  accompanying  individual  sensory  impressions,  may  go 
astray.  "  Darwin  reports  that  young  pointers  point  at  other 
dogs,  a  thing  that  experienced  pointers  never  do.  The  scent 
of  game  induces  the  irresistible  impulse  to  point,  though  there 
is  no  idea  of  the  game  itself"  (Wundt). 

Pathological  Determination  of  the  Undifferentiated  Sexual 
Feeling  by  External  Impressions. — In  the  indefiniteness  of  the 
original  impulses — the  sexual  instinct  as  well  as  the  instinct  for 
food — lies  the  nucleus  of  the  various  errors  to  which  the  indi- 
vidual is  subject.  If,  owing  to  external  circumstances  and  edu- 
cation, the  object  which  nature  has  created  to  induce  sexual 


152  SEXUAL  PARJSSTHESIA. 

excitement  does  not  present  itself  to  gratify  the  longing  for 
satisfaction,  then  the  desire  for  satisfaction,  faute  de  mieux^  turns 
to  the  next  best  means,  especially  when  there  is  ignorance  of 
the  sexual  relations. 

With  premature  awakening  of  the  sexual  appetite,  as  a 
rule,  the  opportunity  for  normal  sexual  intercourse  is  wanting. 
Therefore,  onanism,  brought  about  by  tickling  sensations  in  the 
glans  and  erections,  is  the  most  frequent  result  of  this  sexual 
precocity.  The  sense-impression  which  accompanies  the  first 
orgasm,  brought  about  by  tactile  or  psychical  onanism,  owing 
to  the  intensity  of  the  feeling,  is  much  deeper  than  the  ma- 
jority of  impressions.  The  new  perception,  owing  to  the 
feelings  accompanying  it,  is  retained,  no  matter  how  great  dis- 
parity there  may  be  in  it.  According  to  the  intensity  of  the 
feeling,  the  individual  judges  of  the  value  of  the  perception 
for  the  Ego.  The  perceptions,  both  in  content  and  in  time, 
are  so  intensely  associated  in  thought  that  thereafter  the  lust- 
ful feeling  is  regularly  accompanied  by  the  reproduced  image 
of  the  external  accompanying  conditions.  For  the  very  reason 
that  the  individual  has  experienced  nothing  of  this  kind  before, 
he  will  the  more  recklessly  abandon  himself  to  the  most  intense 
pleasurable  emotion  that  nature  affords,  the  less  resistive  power 
there  is  in  his  nervous  system  as  a  result  of  hereditary  dispo- 
sition. There  is,  too,  no  other  possibility  than  that  the  onan- 
istic  act  of  an  inexperienced  individual  will  reproduce  the 
impressions,  once  discovered  and  brought  about  by  external 
stimuli,  until  experience  offers  other  material.  For  "  nihil  est 
in  intellectu,  quod  non  prius  fuerit  in  sensu." 

Simultaneously,  owing  to  the  nature  of  the  feeling,  occurs 
the  impulse  to  repeat  this  experience  for  the  benefit  of  the  Ego. 
Thus  it  is  deepened  and  completed.  The  thoughts  which  have 
arisen  from  inadequate  external  excitation  are  joined  with 
others,  brought  into  definite  relation  with  the  Ego,  and  the  sum 
of  these  states  of  emotion  becomes  an  enduring  object  for  the 
personality.  Through  the  frequency  of  its  reproduction  the 
definite  idea  may  finally  become  imperative,  and  at  last  in 
itself  be  sufficient  to  produce  sexual  excitement.  In  dreams  it 


HEREDITY  AND  EDUCATION.  153 

accompanies  pollutions,  and  becomes  the  starting-point  of 
sexual  perversions.  Since,  in  the  schools,  education  has 
brought  about  a  strict  separation  of  the  sexes,1  it  is  highly  prob- 
able that  the  first  sexual  promptings — where  there  is  complete 
ignorance  of  sexual  matters — will  be  directed  anywhere  rather 
than  toward  the  opposite  sex.  The  longings  and  promptings  of 
puberty  are  intensified  at  first  in  the  presence  of  another  person, 
no  matter  whether  it  be  a  girl,  a  friend,  a  much-loved  rela- 
tive, or  an  honored  teacher  (Mme.  Lambercier  and  Rousseau). 
The  person  in  whom  there  is  the  greatest  confidence  and  with 
whom  there  is  the  closest  sympathy,  and  who  is  at  hand  at  the 
moments  of  excitement,  will,  according  to  sex  and  accompany- 
ing circumstances,  play  the  determining  part  in  the  origin  of 
the  perversion.2  The  close  boy-and-girl  friendships  that  may  be 
seen  in  every  school,  owing  to  sexual  coloring,  take  on  a  sexual 
character,  even  though  the  individuals  be  unconscious  of  it ; 
and,  therefore,  kissing,  embraces,  jealousy,  tears,  etc.,  are 
common  events.  Then  all  that  is  necessary  is  sexual  hyper- 
excitation,  or  tickling  sensations  in  the  genitals  induced  by 
masturbatic  frictions  (with  the  thighs),  to  intensify  this  sensa- 
tion to  an  unknown  lustful  feeling,  and,  with  reference  to  the 
accompanying  thoughts,  the  sexual  instinct  is  determined, — i.e., 
the  impulse,  seeking  satisfaction,  has  become  conscious  of  its 
object,  even  though  it  be  erroneous. 

The  accompanying  psychical  manifestations  of  sexual  exci- 
tation— that  is,  the  sexual  thoughts — always  depend  upon 
external  impressions,  the  objects  of  which  are  brought  into 
material  relation  to  sexual  feelings.  The  nature  of  the  object 
determines  by  content  the  direction  of  the  sexual  impulse.  The 
form  of  the  perversion — i.e.,  the  object  to  which  the  perverted 
impulse  has  been  directed — is  determined  by  external  circum- 
stances, accidental  events ;  and,  in  our  opinion,  as  a  rule,  and 

1  Not  true  of  the  public  schools  of  the  United  States. — TRANS. 

*  This  statement  seems  too  broad ;  if  this  be  true,  in  the  histories  of  cases  of  sexual 
perversion  we  should  more  frequently  meet  instances  of  incestuous  tendencies ;  for  often 
relatives  stand  in  just  the  relation  to  the  boy  or  girl  indicated  in  the  text.  Compare  the 
translator's  article,  "  Incest,"  in  "  A  System  of  Legal  Medicine,"  vol.  ii,  E.  B.  Treat,  N.  Y. 
— TKANS. 


154  SEXUAL    PAR^ESTHESIA. 

in  the  majority  of  cases,  it  is  not  to  be  ascribed  to  natural 
tendency. 

Hereditary  Lack  of  Resistive  Power,  and  Pathological 
Association. — In  all  forms  of  parsesthesia,  without  respect  to 
whether  it  be  contrary  sexual  instinct,  algolagny,  or  fetichism, 
it  seems  to  us  that  an  essential  factor  is  the  fact  of  the  origin  of 
the  perverse  expression  of  the  sexual  instinct.  It  is  entirely 
subsidiary  that  the  same  patient;  who,  as  a  result  of  external 
circumstances,  in  one  instance  acquires  contrary  sexuality,  in 
another  might  have  become  an  algolagnist,  or  perverse  in 
hetero-sexual  intercourse.  Natural  disposition  alone  cannot 
explain  why  one  becomes  a  lover  of  shoe-nails,  another  of 
ladies'  eyes.  The  theory  of  pathological  association  which 
Binet1  advocates,  allowed  in  the  case  of  fetichism,  but  not  for 
contrary  sexual  instinct,  would  be  inconsequential.  The  advo- 
cate of  the  theory  of  heredity  is  justified  in  laying  the  chief 
stress  upon  congenital  predisposition,  which  supplies  the  basis 
for  the  development  of  any  form  of  psycho-sexual  disease,  and,  at 
the  same  time,  there  is  no  need  to  stretch  this  to  include  the  form 
of  the  disease.  With  a  normal  nervous  system,  we  see  how 
events  coupled  with  intense  emotions  in  early  youth  become 
determinate  for  our  whole  lives.  As  Binet  correctly  remarks, 
when  a  child  has  once  been  frightened  by  a  cat  with  no  help 
at  hand,  or  when  it  has  been  given  a  headache  by  the  intense 
odor  of  a  rose,  the  aversion  for  cats  or  roses  may  have  been 
impressed  upon  the  brain  for  life. 

A  pathological  nervous  system  is  usually  more  easily  and  in- 
tensely impressed;  the  neuropath  is  much  less  able  to  offer  resist- 
ance to  the  sensations  that  have  been  intensely  impressed  upon 
him  in  youth.  The  idea  created  by  the  first  strong  impression  of 
a  sexual  nature  gains  a  growing  mastery  over  him,  and,  for  want 
of  inhibitory  opposition,  forces  him  in  a  pathological  direction. 
"  Such  a  pathological  inclination,  as  Lombroso  says  of  criminals, 
in  some  evil  hour  develops,  especially  during  childhood,  and 
disappears  under  the  influence  of  proper  training.  When, 
however,  it  has  a  favorable  foundation  (predisposition  due  to 

1  Revue  Philoeophique,  Paris,  1887,  No.  8. 


HEREDITY   AND   EDUCATION.  155 

faults  of  development),  and  when  it  is  not  opposed,  it  remains. 
While,  in  the  majority  of  men,  the  reminiscences  of  such  im- 
pressions, for  the  most  part,  influence  them  in  a  subordinate 
way  through  association  of  ideas,  in  the  individual  under  con- 
sideration they  operate  like  certain  kinds  of  virus ;  since  they 
not  only  become  fixed,  but  also  permeate  the  whole  organism 
until  they  absolutely  control  it  and  irresistibly  compel  acts 
which  are  usually  of  a  criminal  character.  Thus  are  explained 
the  strange  perversions  in  the  direction  of  obscenity  and  love 
which  we  see  develop  in  hereditarily  predisposed  individuals  in 
their  youth."1 

The  repetition,  perhaps  voluntary,  of  the  first  experience, 
if  this  induced  sexual  orgasm,  and  the  reproduction  of  the  per- 
ception with  the  onanistic  act  to  which  the  majority  of  such 
individuals  give  themselves,  change  the  vice  into  a  habit,  give 
the  impulses  the  strength  of  imperative  feelings,2  and  leave  but 
one  direction  for  desire.  On  the  other  hand,  in  the  same  degree 
in  which  the  psycho-sexual  anomaly  is  engrafted  in  them,  such 
persons  feel  themselves  impotent  in  normal  intercourse.  Women 
cannot  charm  them  as  long  as  they  find  satisfaction  in  the  per- 
verse activity  of  their  sexual  appetite. 

Psycho-sexual  Diseases,  Moral  Insanity ',  and  Weak-mind- 
edness.— The  common  characteristic  of  sexual  perverts,  there- 
fore, consists  of  this:  in  comparison  with  the  normally-developed 
man  they  have  lost  the  power  to  compensate  the  pathological 
stimulus  by  means  of  the  experiences  of  physiological  sexual 
life  and  the  multitudinous  perceptions  of  life ;  or  they  have 
never  possessed  it,  as  in  hereditary  weak-mindedness. 

1  Comp.  Lombroso,  Der  Verbrecher,  Hamburg,  1887,  p.  119. 

a  During  the  publication  of  this  work  there  appeared,  in  the  Munchener  med. 
Wochenschrift  (1892,  No.  11,  p.  188),  a  notice  of  the  works  by  Moll  and  Krafft-Ebing.  The 
reviewer,  Dr.  Bleuler,  happily  comes  to  an  opinion  similar  to  my  own  ;  at  least,  as  a  result 
of  the  opinion  given  by  Professor  Meynert  on  the  case  of  Couut  Sandor,  Bleuler  says  :  "  If, 
as  a  result  of  any  accidental  circumstances,  these  associations,  which  usually  condition 
the  exclusive  inclination  toward  the  normal  sexual  act,  are  so  directed  that  the  pleasure, 
in  a  broader  sense,  accompanying  the  activity  of  the  sexual  instinct  becomes  associatively 
connected  with  the  idea  of  an  '  unnatural '  act,  or  of  association  with  a  person  of  the 
same  sex,  neurasthenic  individuals  and  those  predisposed  to  imperative  thoughts  often 
cannot  rid  themselves  of  this  association,  and  there  arises  an  enduring  abnormality  of  the 
sexual  instinct."  The  correctness  of  this  idea  of  the  reviewer  is  confirmed  by  examples 
given  later. 


156  SEXUAL    PAR^ISTHESIA. 

From  the  stand-point  of  lack  of  resistive  power  to  patho- 
logical excitation,  and  from  the  stand-point  of  lack  of  inhibitory 
influence  of  our  intelligence  against  intense  stimuli,  the  various 
forms  of  sexual  hypersesthesia  appear,  from  a  single  point  of 
view,  as  members  of  one  family, — ac  symptoms  of  a  pathologi- 
cal condition  wjiich  has  been  designated  moral  insanity.  Moral 
insanity  itself  is  but  a  symptomatic  name  for  certain  pathologi- 
cal manifestations  which  arise  from  a  defect  of  mental  endow- 
ment, or  which,  in  their  course,  lead  to  destruction  of  the  mental 
powers.  According  to  the  views  of  Mendel,  Meynert,  and 
Binswanger,  moral  insanity  signifies  a  variety  of  weak-minded- 
ness which  is  characterized  by  an  abnormal  tendency  to  immoral 
acts ;  a  sign  of  a  low  grade  of  idiocy  which  is  known  under 
the  name  of  "imbecility."  The  lack  of  inhibitory  ideas  (judg- 
ment) presumes  a  defect  in  the  development  of  intelligence,  in 
the  mental  energy,  and  it  goes  hand-in-hand  with  active  stimu- 
lation of  the  animal  instinct.  The  ethical  weakness  exists 
without  disturbance  of  the  understanding,  but  is  often  associated 
with  great  emotional  irritability,  and  makes  such  persons  in- 
capable of  recognizing  and  understanding  immoral  and  illegal 
acts  as  such.  Therein,  in  our  opinion,  lies  also  the  reason  why 
urnings  but  seldom  designate  their  sexual  instinct  (comp.  Moll, 
p.  205)  as  abnormal. 

The  instinctive  and  usually  premature  stimulation  of  the 
sexual  sphere  leads  to  perverse  acts  and  onanism.  Therefore, 
the  perverse  activity  is  always  to  be  regarded  as  merely  one  of 
the  manifestations  of  a  nervous  or  mental  disease.  Too,  the 
impossibility  in  some  cases  of  demonstrating  other  abnormal 
symptoms  than  those  of  the  sexual  sphere  must  not  lead  us 
astray.  For,  as  in  all  other  diseases,  in  the  perverse  manifesta- 
tions of  the  sexual  instinct  there  are  numerous  transitional 
forms  and  varieties,  from  the  slightest  deviation  from  the  physi- 
ological condition  to  the  pronounced  psychosis.  Thus  the  old 
question  whether  contrary  sexual  instinct  is  to  be  regarded  as 
"  neuropathic  "  or  "  psychopathic  "  becomes  meaningless.  For 
it  may  be  met  as  a  symptom  in  apparently  normal  individuals 
as  well  as  in  cases  of  psychopathic  weakness  dependent  upon 


HEREDITY   AND   EDUCATION.  157 

congenital  disposition,  taint,  and  degeneration,  and  in  pro- 
nounced psychoses  (paralytic,  senile,  epileptic  pederasty). 

Transitional  Cases  and  Lessened  Responsibility. — As  it  is 
impossible  to  regard  crime  in  all  cases  as  the  result  of  patho- 
logical conditions,  in  spite  of  the  correctness  of  the  view  that 
many  crimes  owe  their  origin  to  abnormal  mental  conditions, — 
i.e.,  abnormalities  of  "those  complex  activities  of  brain  which 
are  inherited  and  automatic,  and  which  we  call  character " 
(Forel), — so  the  medical  expert  is  not  called  upon  to  allow  that 
the  isolated  existence  of  perverse  expressions  of  the  sexual  in- 
stinct occasions  "  irresponsibility."  On  the  other  hand,  the 
unequivocal  proof  of  psychopathic  weakness  should  justify  the 
assumption  forensically,  if  not  of  temporary  complete  suspension 
of  the  freedom  of  the  will,  at  least  of  lessened  responsibility. 

In  case  of  gradually-developing  mental  weakness,  the  diag- 
nosis is  more  difficult.  In  such  individuals  it  is  necessary  to 
compare  the  present  state  of  lessened  mental  activity  with  the 
former  normal  state.  "  Defective  power  of  judgment,  insuffi- 
cient acuteness  of  critique,  inability  to  distinguish  the  essential 
from  the  unessential,  want  of  independent  effort  to  investigate 
the  cause  and  nature  of  things,  mental  one-srdedness,  loss  of 
creative  power  and  originality  of  thought,  are  expressions  of 
mental  deterioration  and  diminished  intelligence  of  various  de- 
grees which  it  is  difficult  to  grasp.  The  manner  of  receiving 
external  impressions  and  their  fixation  in  consciousness,  memory, 
understanding,  logical  powers,  mood, — all  must  be  taken  into 
consideration  in  forming  such  an  opinion.  With  diminution  of 
intelligence  and  blunting  of  the  feelings  there  is  a  want  of  the 
most  powerful  means  of  opposing  the  desires,  the  morality  of 
which  is  judged  by  the  understanding  and  estimated  by  the 
feelings  "  (Tarnowsky). 

There  are  sensual  persons  in  whom,  at  certain  periods  of 
life,  the  sexual  functions  are  the  most  important  thing  in  life. 
As  soon  as  sexual  power  begins  to  diminish,  as  a  result  of  ex- 
cesses, they  resort  to  various  means  to  increase  them.  In  this 
way  there  may  arise  a  combination  of  impotence  and  sexual 
debauchery.  Imitation  is  here  one  of  the  most  powerful  means 


158  SEXUAL    PAR^ESTHESIA. 

of  spreading  vice.  Here  the  abnormal  kinds  of  sexual  activity 
do  not  arise  impulsively  from  personal  need,  from  organic  neces- 
sity. The  debased  man  employs  all  means  that  can  add  to  his 
lustful  pleasure,  but,  notwithstanding  the  greatest  recklessness, 
is  still  able  to  control  himself  on  occasion.  Indefinitely  marked 
transitional  cases,  in  which  it  is  impossible  to  decide  where  vice 
ceases  and  disease  begins,  are  likewise  not  infrequent.  But  false 
philanthropy,  in  doubtful  cases  of  "  pathological  viciousness," 
can  only  lead  to  the  spread  of  immorality. 

Sexual  Instinct  in  Imbeciles. — In  numerous  cases  which 
we  find  in  literature,  namely,  in  those  where  effemination  has 
reached  full  development,  there  is,  doubtless,  mental  weakness. 
Sollier1  finds  absence  and  perversion  of  the  sexual  instinct  in 
idiots,  but  in  imbeciles  principally  excessive  intensification  and 
inversion  of  it.  The  imbeciles  often  present  an  infantile  con- 
dition of  the  sexual  organs  (Count  Sandor),  defect  of  sexual 
power,  cryptorchism,  phimosis,  hypospadiasis,  varicocele,  arrest 
of  development  and  atrophy  of  the  testicles,  defective  develop- 
ment of  the  penis,  etc. 

The  onanism  of  idiots,  as  a  rule,  is  not  to  be  regarded  as 
an  expression  of  the  sexual  instinct,  as  we  have  shown  (Mag- 
nan).  On  the  other  hand,  imbeciles  often  manifest  premature 
development  of  the  instinct  and  sexual  perversions.  Onanism  is 
most  frequent  in  the  form  of  automatic  masturbation  as  well  as 
for  sexual  satisfaction ;  also,  mutual  onanism  and  pederasty. 
Too,  there  may  be  observed  in  them  an  especial  tendency  of  the 
mind  to  obscene  talk  and  gestures,  which  would  be  repugnant 
to  a  normally-developed  person. 

The  alterations  of  sexual  activity  may  also  occur  period- 
ically and  in  the  form  of  attacks,  while  during  long  intervals 
all  is  normal, — as  in  periodical  psychoses. 

Original  Disposition  in  Parmsthesia  Sexualis  and  its 
Proofs. — If  now,  in  accordance  with  the  foregoing  view  of  the 
causes  and  development  of  the  anomalies  of  the  sexual  instinct, 
we  once  more  consider  the  hereditary  relations  previously  de- 

1  Der  Idiot  und  Imbecile  (Voss,  -Hamburg,  1891),  p.  75,  and  Bournevllle  and  Sollier, 
Des  anomalies  dee  organs  g6ultaux  chez  les  idiots  et  epileptiques  (Progres  M6d.,  1887). 


HEREDITY    AND    EDUCATION.  159 

scribed,  we  may  express  our  opinion  as  follows :  Since  only  in  the 
worst  forms  of  hereditary  degeneration  are  pathological  states, 
as  such,  transmitted,  it  cannot  be  denied  that  there  is  a  possi- 
bility of  a  repetition  of  the  same  form  of  disease,  the  same 
symptom-complex,  directly  or  atavistically,  in  descendants.  In 
accordance  with  this,  therefore,  in  contrary  sexual  instinct 
there  might  be  such  a  thing  as  the  preformation  of  the  feminine 
type  in  the  male  body  without  the  influence  of  education  and 
example.  Quite  analogously,  the  son  of  a  shoe-fetichist  might 
be  a  shoe-fetichist,  and  thus  algolagny  arise  from  an  original 
disposition. 

These  cases,  however,  even  if  they  occur  at  all,  are  the 
exception  in  common  practice.  As  a  rule,  the  transmission  must 
be  regarded  as  that  of  an  hereditary  lack  of  resistive  power, 
which  may  well  affect  the  sexual  sphere  by  preference.  On  the 
other  hand,  the  full  development  of  the  anomaly  in  the  in- 
dividual depends  upon  various  accidental  factors.  The  influ- 
ences of  the  individual's  life  are,  in  the  majority  of  such 
patients,  determinate  for  the  development  of  the  form  of  the 
psycho-sexual  disease. 

But  if,  as  acknowledged,  the  possibility  of  the  occurrence 
of  contrary  sexual  instinct  as  an  hereditary  symptom-complex, 
without  or  in  spite  of  opposing  education,  cannot  be  denied, 
still,  literature  does  riot  yet  afford  an  incontestable  example  of 
it.  Moll  (p.  159)  gives,  as  evidence  of  the  original  disposition, 
the  circumstance  that  "  in  most  pederasts  and  urnings  the  per- 
version dates  back  to  the  earliest  childhood."  The  same  author 
looks  upon  acquired  cases  as  those  in  whom  there  was  first 
inclination  toward  women,  later  toward  men.  This  assumption 
seems  to  derive  further  support  from  the  fact  that  the  impulse 
to  play  the  feminine  role  occurs  prior  to  the  time  of  the  first 
sexual  promptings,  and  that  in  spite  of  education.  If,  in  such 
cases,  the  sexual  feeling  is  directed  toward  the  same  sex,  and 
without  the  occurrence  of  hetero-sexual  feelings,  then  the 
"  hereditarily-conditioned  process  "  seems  to  complete  its  nat- 
ural development. 

This  anthropological  transformation  reaches  its  acme  when 


160  SEXUAL    PAR^ESTHESIA. 

not  only  the  character,  but  also  the  skeleton,  face,  and  voice 
correspond  with  the  abnormal  sexual  type  (defective  develop- 
ment of  beard,  development  of  mammae,  abundant  development 
of  adipose  tissue),  to  which,  as  a  rule,  other  anatomical  and 
functional  signs  of  degeneration  are  added. 

Objections. — But  there  may  be  serious  objections  raised 
to  these  considerations.  The  significance  of  the  sexual  factor 
in  the  development  of  mind  and  character  is,  of  course, 
too  important  and  determinate  to  be  overlooked.  Neverthe- 
less, it  seems  to  us  to  be  necessary,  in  the  interest  of  precise 
definition,  to  decide  the  question  which  Westphal  raised,  and 
which  has  been  much  defended  by  urnings,  whether  an  indi- 
vidual with  inclinations  toward  feminine  pursuits,  but  feeling 
normal  sexually,  is  to  be  regarded  as  of  contrary  sexuality. 
In  our  opinion,  only  the  sexual  element  is  to  be  looked  upon  as 
the  determining  one,  and,  to  a  certain  extent,  it  insures  the 
diagnosis.  Thus,  for  example,  I  am  acquainted  with  a  cavalry 
officer  who  is  a  happy  father  and  devoid  of  sexual  anomalies ; 
but  he  shows  a  great  liking  for  feminine  pursuits ;  he  embroid- 
ered all  the  coverings  of  his  furniture  himself.  In  spite  of  his 
feminine  habits,  I  do  not  regard  him  as  of  contrary  sexuality. 
Likewise,  I  know  a  male  nurse  who  knits  his  own  stockings, 
cooks,  and  shows  preference  for  other  kinds  of  female  work. 
He  is  perfectly  normal  sexually  (verbal  examination),  and  the 
happy  father  of  nine  children.  Therefore,  so  long  as  the  devia- 
tion from  the  same  sex  does  not  involve  the  sexual  feeling,  we 
are  not  justified,  even  in  cases  of  the  most  remarkable  opposite 
peculiarities  which  nature  presents  in  many  individuals,  in 
speaking  of  a  pathological  phenomenon.  Even  when  the  femi- 
nine inclinations  go  to  the  extent  of  self-adornment,  to  the 
habitual  use  of  perfumes  and  other  unmanly  arts  of  the  toilet, 
the  same  position  holds  good.  Skill  in  cooking,  knitting,  and 
sewing,  without  teaching  and  imitation,  is  impossible,  and 
therefore,  for  the  most  part,  the  result  of  education. 

In  support  of  the  above-mentioned  anatomical  transforma- 
tion (development  of  mammae,  absence  of  beard,  masculine  feet 
in  women)  we  may  cite  the  observations  made  on  eunuchs  (who 


HEREDITY    AND    EDUCATION.  161 

lose  the  secondary  sexual  characteristics  after  emasculation)  and 
the  cultivation  of  mujerados.  Here  it  cannot  be  denied  that 
there  is  a  certain  correspondence  between  the  physical  phenom- 
ena and  the  psycho-pathological  symptoms.  But,  as  von  Krafft- 
Ebing  expressly  points  out,  with  contrary  sexual  instinct  physical 
hermaphroditism  has  never  been  observed ;  and,  on  the  other 
hand,  in  hermaphrodites  there  have  always  been  found  the  char- 
acteristics and  psycho-sexual  peculiarities  of  but  one  sex.1 
Too,  in  this  respect,  nature  presents  remarkable  variations ;  so 
that,  with  consideration  of  these  conflicting  facts,  conclusions 
are  to  be  drawn  only  with  the  greatest  care.  Thus,  I  know 
several  cases  in  which,  in  perfect  (physically  and  sexually)  mas- 
culine individuals,  there  was  development  of  female  mammae. 
One  of  my  patients  presented  this  remarkable  condition ;  he 
also  had  a  high,  thin  voice,  was  slenderly  formed  and  neuro- 
pathic, but  devoid  of  psycho-sexual  anomaly. 

The  following  personal  observation,  made  in  October  of 
last  year,  also  speaks  against  the  rule  of  anatomical  correspond- 
ence. It  was  the  case  of  a  bearded  woman.  She  was  tall; 
pelvis  feminine  ;  hands  and  feet  large.  Abundant  development 
of  subcutaneous  adipose  tissue ;  breasts  well  developed ;  hair 
thick  and  long  and  dark ;  cheeks,  chin,  and  lips  covered  with 
a  thick  blonde  beard  of  soft  hair  about  six  or  seven  centimetres 
long ;  voice  deep  and  rough  (like  a  man's) ;  genitals  perfectly 
feminine;  age  34  years;  menses  began  at  the  age  of  20  years. 
She  had  been  happily  married  nine  years,  and  was  the  mother 
of  one  child.  She  loved  her  husband,  and,  with  the  exception 
of  a  strong  will,  she  presented  no  masculine  characteristics. 
She  was  entirely  indifferent  to  the  female  sex,  and  had  intense 
lustful  pleasure  in  hetero-sexual  intercourse. 

Arrests  of  development  of  organs  well  differentiated  sexu- 
ally, as  occasionally  observed  in  individuals  of  contrary  sexu- 
ality, are  to  be  regarded  as  degenerative  signs,  as,  for  example, 
when  observed  in  imbeciles.  They  exist  independently  of  the 
psycho-sexual  anomaly. 

The  etiological  role  of  the  educational  factors  and  imagines 

"Tardieu  et  Langier,  Diet,  de  m6d.,  art.  "  Hermaphrodisme." 
11 


162  SEXUAL    PAR^STHESIA. 

tion  may  be  more  precisely  defined  from  experience  that  is  at 
hand.  The  influences  exerted  on  the  child  may,  with  defect  of 
understanding,  have  an  effect  exactly  opposite  to  that  intended; 
unconscious  suggestion,  in  the  education  of  children,  plays  at 
least  as  important  a  role  as  systematic  instruction.  The  ques- 
tion is,  whether  a  child  devoid  of  hereditary  taint  can  become 
contrary  sexually  by  cultivation ;  the  possibility  of  artificial 
transformation — the  extraordinary  extent  of  human  influences — 
after  the  historical  and  ethnographical  facts  adduced,  can  no 
longer  be  doubted. 

The  importance  of  the  educational  factor  becomes  perfectly 
clear  after  a  consideration  of  cases  in  which  this  point  is  brought 
out,  and  we  shall  later  make  some  contributions  bearing  on 
this  point.  Unfortunately,  in  the  majority  of  histories  of  cases, 
this  important  point  is  not  sufficiently  considered.  As  a  rule, 
such  persons,  as  already  mentioned,  consult  the  physician  only 
after  they  are  forced  to  by  nervous  or  other  symptoms.  The 
physician  sees  before  him  a  many-sided  symptom-complex ;  and 
if,  with  difficulty,  he  is  able  in  every  case  to  determine  the 
degree  of  the  deviation  from  the  normal,  and  to  recognize  the 
anomaly  of  feeling  as  one  of  the  phenomena  of  a  deeper  proc- 
ess, still  it  will  be  often  impossible  to  decide  what  is  primary, 
what  is  hereditarily  conditioned,  and  what  has  developed 
secondarily.  Thus,  according  to  our  view,  the  manifestations 
of  eflemination  occur,  as  a  rule,  secondarily,  as  a  product  of 
accommodation.  Besides,  the  physician,  in  examining  the 
patient,  has  to  depend  largely  upon  his  statements,  and,  owing 
to  the  required  discretion,  cannot  control  them  by  statements  of 
the  relatives.  Too,  almost  every  urning  has  formed  his  own 
theory;  as  the  autobiographies  in  the  "  Psychopathia  Sexualis" 
of  Professor  von  Kraft't-Ebing  show,  the  persons  of  contrary 
sexuality  who  have  not  read  that  work  are  the  exceptions. 
Unconscious  auto-suggestion  and  retro-active  illusions  of  memory 
concerning  the  events  of  early  years  give  the  histories  a  very 
uncertain  basis.  To  this  is  added  the  pathologically  intensified 
auto-suggestibility  of  such  neurasthenics,  which  hinders  in  every 
way  objective  judgment. 


HEREDITY    AND    EDUCATION.  163 

The  essential  influences  which  determined  the  patient's 
sexual  development  are  forgotten  ;  the  theory  of  heredity  shields 
him  from  responsibility  ;  concerning  the  time  of  the  first  occur- 
rence of  sexual  inclinations  he  is  often  unable  to  make  any 
definite  statements,  because  the  knowledge  of  the  sexual  re- 
lations followed  only  years  after,  and  thus  he  seeks  to  explain 
the  first  signs  of  effemination  by  his  original  disposition,  while, 
in  fact,  they  are  only  resultant  phenomena.  If  these  auto- 
biographical data  are  indispensable  to  the  physician,  still  their 
value  should  not  be  placed  so  high  that  they  are  made  the 
foundation  of  a  wide-reaching  scientific  theory.  The  explana- 
tory principles  should  not  be  increased  unnecessarily;  and  to 
heredity,  that  unknown  factor  for  us,  phenomena  should  not  be 
ascribed  which  may  be  easily  explained  by  education  and  the 
effect  of  life. 

The  first  intense  sexual  excitement  may  very  easily  occur 
in  contact  with  an  attractive  male,  without  the  necessity  for  the 
presence  of  hereditary  predisposition,  even  though  the  latter  can 
be  demonstrated  in  the  majority  of  cases.  The  previously  un- 
differentiated  feeling  now  has  an  object,  and  may,  as  a  result  of 
external  influences,  easily  become  developed  into  contrary 
sexual  feeling  before  hetero-sexual  feelings  manifest  themselves ; 
and  if  in  such  a  case  the  latter  occur,  which  in  healthy,  un- 
tainted individuals  must  be  the  rule,  the  inclination  toward 
women  is  later  than  that  toward  men, — a  contradiction  of 
Moll's  view  previously  mentioned,  according  to  whom  this  factor 
is  of  decisive  diagnostic  significance  for  the  original  disposition. 
An  imperative  idea  may  be  the  starting-point  of  final  complete 
effemination.  If,  among  the  perverse  manifestations  of  the 
sexual  appetite,  contrary  sexual  instinct  cover  the  broadest 
field,  and  seem,  for  the  most  part,  to  be  a  peculiar  freak  of 
nature,  or  to  form  a  special  pathological  group,  so  that  it  has 
led  to  the  expression  "  a  feminine  soul  in  a  masculine  body," 
still  this  depends  principally  upon  modern  education  and  the 
injurious  separation  of  the  sexes  in  schools. 

Those  persons  in  whose  presence,  or  in  whose  companion- 
ship, the  first  sexual  excitement  is  experienced,  are,  in  these 


164  SEXUAL    PAR^ESTHESIA. 

cases,  of  like  sex ;  too,  the  fetichist,  before  he  has  erections  at 
the  sight  of  lifeless  objects,  primarily,  at  least  as  a  rule,  becomes 
attached  to  some  living  person.  The  accidental  causes,  even 
in  spite  of  the  lively  emotional  accompaniment,  are  often  for- 
gotten by  the  patients;  still  in  some  cases,  in  which  detailed 
biographies  of  urnings  had  been  furnished,  and  from  which  no 
other  explanation  could  be  drawn  than  that  of  a  congenital 
abnormality,  I  succeeded,  after  repeated  careful  examination,  in 
awakening  memory  of  apparently  inconsequential  events  which 
were  the  keys  to  the  physiological  understanding  of  the  disease. 
The  fact  that  the  remarkable  perversions  of  taste  of  fetichists 
cannot  be  explained  without  the  assumption  of  pathological 
association  should  point  to  the  importance  and  the  presence  of 
a  similar  phenomenon  in  sexual  inversion.  The  symptomatic 
picture  which  the  patient  presents  to  the  physician  on  exami- 
nation, usually  in  all  the  forms  of  parassthesia,  represents  the 
ultimate  product  of  an  abnormal  development  that  has  existed 
several  years  or  even  decades, — the  result  of  a  great  number  of 
experiences  and  influences.  Compared  with  its  beginning,  the 
result  is  totally  different ;  and  there  may  be  nothing  in  the  latter 
to  recall  the  first  associations,  so  important  for  the  psychological 
analysis. 

Thus,  too,  the  most  horrible  of  the  sexual  perversions, 
necrophilia,  confirms  the  above-mentioned  disastrous  effect  of 
the  ideas  accompanying  the  onanistic  act,  which,  with  a  lively 
fancy,  calls  up  changing  images,  any  one  of  which,  in  a  brain 
easily  influenced  by  suggestion,  may  filially  become  an  impera- 
tive idea.  The  auto-suggestive  idea  may  induce  an  instinctive 
impulse  to  act, — a  state  of  temporary  impulsive  insanity.  The 
performance  of  the  ideal  act,  auto-suggested  or  produced  by 
external  impressions,  depends  upon  whether  moral  conscience  is 
strong  enough  to  balance  the  great  suggestibility. 

Thus,  Tardieu1  reports  the  case  of  an  onanist  whose  hetero- 
sexual instinct  was  well  developed,  but  who  masturbated  seven 
or  eight  times  daily.  He  said :  "  While  masturbating,  my 

1  Attentats  aux  Mceurs,  Paris,  1878,  p.  114  ;  also  reported  at  length  in  Psychopathia 
Sexualis,  p.  69,  Case  28. 


HEREDITY   AND   EDUCATION.  165 

imagination  places  me  in  a  room  filled  with  women  in  my 
power.  While  I  satisfied  my  lust  on  them,  in  thought,  I  sacri- 
ficed them  always  in  the  same  way  to  my  lust ;  imagined  them 
dead,  and  then  violated  their  bodies.  Sometimes  fhe  thought 
came  to  me  to  cut  up  a  male  body;  but  that  was  always  seldom, 
and  disgusted  me."  The  patient  then  began  to  carry  out  his 
fancies  practically.  At  first  he  masturbated  at  the  sight  of  the 
bodies  of  animals  that  had  been  cut  open  ;  then  he  killed  dogs, 
and  finally  exhumed  human  corpses.  "All  that  one  experiences 
with  a  living  woman,"  said  he,  "is  nothing  in  comparison  with 
the  pleasure  I  enjoyed.  I  covered  their  bodies  with  kisses, 
pressed  them  wildly  to  my  heart;  in  a  word,  I  overwhelmed 
them  with  the  most  passionate  caresses.  Then  I  would  cut  up 
the  body,  tear  out  the  entrails,"  etc. 

Fetichism  offers  instructive  examples  for  the  theory  of  patho- 
logical association.  In  the  well-known  case  of  the  lover  of  night- 
caps, the  occurrence  of  the  first  sexual  excitement  coincided  with 
the  sight  of  a  night-cap  which  was  put  on  by  an  aged  relative 
who  slept  in  the  same  bed.  The  next  erection  occurred  when 
the  patient  saw  an  old  female  servant  put  on  her  night-cap. 
Thus  a  mental  association  was  formed  at  an  age  when  mental  im- 
pressions are  always  very  deep.  An  apron-fetichist,  at  the  age 
of  15,  saw  an  apron  fluttering  in  the  wind ;  he  took  it  and  put 
it  around  himself,  in  order  to  masturbate  while  in  it.  Mental 
associations  thus  formed  become  imperative  ideas,  because  the 
patients  are  hereditarily  predisposed,  and  in  this  way  determine 
the  direction  of  the  sexual  life. 

The  psychical  condition  in  which  associations  of  such  sig- 
nificance occur  Binet  has  appropriately  compared  to  a  state  of 
intensified  suggestibility.  In  themselves,  the  objects  with  which 
sexual  excitement  becomes  associated  are  often  incapable  of 
affording  satisfaction  ;  it  is  the  reproduction  of  the  associated 
ideas  and  feelings  which  give  them  their  significance.  Thus, 
the  desire  for  generalization  and  abstraction,  which  is  constantly 
recurring  in  these  perversions, .  becomes  explicable ;  and  this, 
in  the  course  of  time,  may  entirely  change  the  content  of  the 
perversion.  A  man  who  loved  a  red-haired  woman  finally 


166  SEXUAL    PARJESTHESIA. 

could  not  see  red  hair  without  becoming  sexually  excited.  The 
former  lover  of  an  Italian  girl  always  had  an  erection  at  the 
sight  of  an  Italian  costume.  An  original  lover  of  white  aprons 
was  finally  excited  by  every  white  apron  he  saw,  and  at  last  by 
white  alone  (on  a  mason).  From  the  time  of  his  first  love 
Descartes  had  a  partiality  for  squinting  eyes.  In  general,  the 
peculiarities  which  we  have  once  loved  in  one  person  always 
have  the  greatest  attraction  for-  us  in  others. 

The  tendency  to  separate  the  object  of  love  from  its  sur- 
roundings, as  it  is  manifested  in  pathological  fetichism,  may  be 
regarded  as  abstraction.  The  shoe-fetichist  shows  next  a  prefer- 
ence for  the  nude  female  foot, — an  inclination  which,  without 
striving  for  isolation  and  without  separate  sexual  excitement,  is 
still  physiological.  The  dressed  female  foot  forms  the  transition, 
and  the  love  of  shoe-nails  the  pathological  ultimate  result. 
Tarnowsky l  reports  that  the  inclination  for  furs,  in  a  mastur- 
bator  12  years  of  age,  arose  from  the  bodily  contact  with  a  dog 
that  he  sometimes  took  to  bed  with  him.  Transition  :  coinci- 
dence of  onanism  and  the  touch  of  the  dog.  Finally,  the  touch 
of  the  dog  alone  induced  excitement  and  ejaculation.  Later, 
only  by  means  of  touching  fur  could  he  induce  sexual  excite- 
ment. Here,  also,  we  have  to  do  with  the  effect  of  pathological 
association  and  the  tendency  to  generalization  in  a  degenerate 
individual. 

The  effort  to  intensify  the  cause  of  the  pleasure  and  the 
sexual  excitement  indicates  a  longing  for  more  powerful  stim- 
uli, and  this,  according  to  Binet,  presumes  a  weakening  of  the 
power  of  reaction  of  the  nerves,  and  therefore,  in  the  history  and 
in  physiology,  it  is  to  be  regarded  as  a  sign  of  decadence.  Even 
savages  make  prominent  those  portions  of  the  body  which  they 
especially  prefer ;  the  natives  of  western  America  form  the  hair 
in  knots  in  order  to  enlarge  the  head ;  the  Chinese  seek  to  make 
the  feet  small ;  Europeans  try  to  make  the  breasts  more  promi- 
nent by  means  of  tight  lacing.  The  courtesan  colors  her  eye- 
lids to  enlarge  the  eyes  and  accentuate  the  brilliancy  of  the 
sclerotic.  Also,  among  individuals  of  contrary  sexuality  there 

1  Op.  ctt.,  p.  22. 


HEREDITY    AND    EDUCATION.  167 

is  the  effort  to  magnify.  Thus,  the  urning  who  tries  to  copy 
woman  exaggerates  the  specific  feminine  peculiarities,  often  to 
caricature;  and,  vice  versd,  the  female  in  male  attire  (Count 
Sandor)  those  of  man. 

The  restraint  which  is  often  enough  connected  with  the 
fact  of  specific  sexual  reaction  to  stimuli  that  are  not  always 
attainable  intensifies  the  sexual  pervert's  power  of  imagination 
and  longing  for  satisfaction.  From  this  may  be  recognized  the 
correctness  of  the  experience  that  regulated  sexual  intercourse 
is  the  most  effectual  antidote  against  the  development  of  the 
anomaly. 

The  foregoing  considerations  show  that  the  changes  which 
the  content  of  the  sexual  perversions  may  undergo  in  the  course 
of  time  are  essentially  to  be  referred  to  the  tendency  of  such 
patients  to  generalize,  to  isolate,  and  to  exaggerate.  These  three 
peculiarities,  however,  are  at  bottom  only  different  forms  of 
expression  of  a  single  tendency  peculiar  to  the  human  imagi- 
nation,— namely,  that  of  exaggeration.  It  may  be  intensified  by 
pathological  relations  and  abstinence. 

The  Exciting  Cause  in  the  Histories  of  Timings  and  Other 
Sexual  Perverts. — It  remains  to  give  a  critical  review  of  the 
known  cases  of  sexual  parsesthesia,  and  in  them  to  try  the  cor- 
rectness of  the  view  here  set  forth,  and  especially  to  point  out 
such  cases  as  are  exceptions. 

In  his  "Clinical  Novels,"  Caspar  reports  the  autobiogra- 
phy of  an  inveterate  pederast,  from  which  we  borrow  the  fol- 
lowing passage,  so  important  in  showing  the  etiology  of  this 
case  \ 

"  As  a  school-boy  of  eight  I  sat  near  a  boy  somewhat  older.  How 
happy  I  was  when  he  touched  me !  It  was  the  undefined  feeling  of  an 
inclination  which  was  a  secret  to  me  until  my  nineteenth  year.  I  have 
never  masturbated  nor  committed  abuse  with  other  boys.  There  were 
some  certain  ones  toward  whom  I  felt  an  unconquerable  inclination,  and 
to  whom  I  indited  my  verses." 

In  sexual  intercourse  with  women  (at  eighteen)  he  thought  of  his 
friend,  and  therefore  had  no  pleasure ;  but  "a  wonderful  feeling  of  joy  " 
came  over  him  when  an  unknown  man  in  the  Zoological  Garden  first 
satisfied  him  by  means  of  masturbation. 


168  SEXUAL    PAR^ESTHESIA. 

Here  we  observe  premature  awakening  of  sexual  impulses, 
transference  of  the  undifferentiated  feeling  to  the  pupil  touching 
him,  passive  onanism,  and  definite  perversion  of  the  instinct  in 
a  predisposed  individual. 

From  WestphaPs  first  case  we  take  the  following  passage : 

"  N.,  it  is  said,  suffers,  since  her  eighth  year,  with  a  passion  to  love 
women,  and,  besides  kissing  and  joking  with  them,  to  masturbate.  She 
states  that  she  has  never  had.  intercourse  and  never  any  inclination 
to  it.  Playing  with  them  gave  her  such  a  sensual  delight  that  she  had 
actual  orgasm.  When  a  child  she  liked  to  play  boys' games  and  dressed 
like  a  boy.  She  had  experienced  sexual  excitement  since  puberty  in 
kissing  girls."  1 

She  masturbated  shortly  before  and  after  menstruation.  In  other 
respects  the  patient  presented  the  female  type. 

Though  in  this  case  more  exact  details  could  be  desired, 
still  it  may  be  seen  from  the  report  that  there  were  (a)  prema- 
ture awakening  of  the  sexual  instinct,  (5)  relation  to  the  same 
sex,  and  (c)  masturbation.  On  the  other  hand,  it  is  not  clear 
whether  the  inclination  to  boys'  play  was  present  before  or  after 
the  sexual  inclinations  for  the  female  sex.  Too,  this  case  does 
not  contradict  our  theory,  and,  like  Caspar's  case,  does  not 
require  a  forced  explanation. 

At  this  place  it  may  also  be  pointed  out  that  the  theory  of 
the  development  of  the  female  character  in  the  male  body  really 
owes  its  origin  to  the  dualistic  ideas  of  timings  (Ulricas).  West- 
phal2  cites  a  number  of  passages  from  "  Numa  Numantius's  " 
investigations  of  the  enigma  of  male  sexual  love  of  males,3  and, 

1  Westphal,  loc.  eit. 

*  Loc.  cit. 

*  Compare  the  following  writings  of  the  author  mentioned  :  "  Forschungen  iiber  das 
Rathsel  der  mannannlichen  Liebe  :  Numa  Numantius  (Karl   Heinr.  Ulrichs)."     "  Vin- 
dex  "  :  Social  and  legal  studies  of  male  love  of  males.     Proof  that  it  deserves  punishment 
as  little  as  love  of  women,  and  that,  according  to  the  existing  laws  of  Germany,  it  cannot 
be  legally  punished.     Leipzig,  1864.     "  Inclusa  "  :  Anthropological  studies  of  male  love  of 
males.     Proof  that  in  a  certain  class  of  individuals  of  masculine  form  sexual  love  of  males 
is  congenital  sexually.    Leipzig,  1864.    "  Vindicata"  :  Struggle  for  freedom  from  persecu- 
tion.    Criminal  details  and  legislative  proposals,  looking  to  a  revision  of  existing  criminal 
laws.     Diary  of  an  urning,  Leipzig,  18fJ5.     "  Formatrix  "  :  Anthropological  studies  of  the 
love  of  urnings.     Description  of  the  sexual  nature  of  uruings  in  detail.     Key  to  the  riddle 
of  uranism  and  its  varieties.    Leipzig,  1865.    "  Ara  spei  "  :  Studies  in  moral  and  social  phi- 
losophy in  relation  to  the  love  of  urnings.    Relation  of  the  urning's  love  to  morality,  Chris- 
tianity, and  the  moral  arrangement  of  the  world.     Moral  justification  of  the  urning's  love. 


HEREDITY   AND   EDUCATION.  169 

therefore,  was,  perhaps,  under  the  influence  of  the  unconscious 
suggestion  of  this  theory.  He  emphasizes  that  the  feminine 
type  is,  embryologically,  preformed  in  the  infant,  and  favors  the 
monistic  and  untenable  conception  of  the  imprisonment  of  a 
feminine  soul  in  a  male  body.  These  writings  lay  stress  upon 
the  feminine  inclinations  of  boys,  and  seek  in  every  way  to 
defend  uranism.  The  time  of  the  primary  sexual  excitation 
and  accidental  factors,  education,  etc.,  receive  so  little  consider- 
ation that  these  studies,  though  highly  interesting  from  the 
stand-point  of  present  investigation,  carry  with  them  no  weight 
of  demonstration. 

All  the  latest  literature  of  uranism  shows  traces  of  the  in- 
fluence of  Ulrich's  theory.  Important  and  fundamental  as 
Westphal's  observations  are  for  psychopathia  sexualis,  they  do 
not,  as  he  himself  states,  afford  an  incontestable  proof  that  con- 
trary sexual  instinct  is  congenital ;  still,  both  cases  show  great 
hereditary  taint,  which,  however,  only  under  the  directing  in- 
fluence of  exciting  causes,  became  developed  into  contrary 
sexual  instinct.  Both  patients,  from  youth  up,  presented  a 
slight  degree  of  psychical  weakness;  and,  as  one  of  the  symp- 
toms of  it,  the  sexual  perversion  was  developed  as  a  result  of 
external  excitation. 

Too,  in  WestphaPs  second  case  there  was  premature 
awakening  of  the  sexual  instinct  (in  the  eighth  year).  The 
patient  who  states  that  in  his  youth  he  had  a  preference  for 
feminine  pursuits,  says  himself:  "  I  have  had  some  inclination 
for  sexual  intercourse  with  women,  though  seldom ;  for  I  feared 
to  become  ugly." 

According   to    this,    then,    there  was   desire    for   women, 

Love-bond  of  urnings.  The  conflict  of  urniugs  and  its  solution.  The  exceptional  place  of 
love  in  the  moral  status  of  the  world.  Hope.  Leipzig,  1865.  "  Gladius  furens":  The 
enigma  of  nature  in  the  urning's  love,  and  error  as  a  maker  of  laws.  An  arraignment  of 
German  laws.  Kassel,  1868.  "  Memnoii  "  :  The  sexual  nature  of  the  male-loving  urning. 
Psycho-physical  hermaphroditism.  Ainina  mitliebrte  virili  corpora  inclusa.  A  study  in  natu- 
ral science.  Two  parts,  Schleiz,  1868.  "  Incubus  "  :  Urniug's  love  and  blood-thirstiness. 
A  consideration  of  abnormal  states  of  mind  and  responsibility,  occasioned  by  the  case  of 
Zastrow,  Berlin  ;  with  fifteen  allied  cases.  Leipzig,  1869.  "Argonauticus"  :  Zastrow  and 
the  urnings  belonging  to  the  camp  of  the  pietists,  ultramoutaues,  and  free-thinkers,  with 
considerations  concerning  blood-thirstiness  and  responsibility  and  brief  reports  from  the 
world  of  urnings  and  the  criminal  cases  :  Bishop  Morell,  of  Edinburgh  ;  Count  Czarnechy, 
of  Posen  ;  Superintendent  Forstner,  of  Vienna.  Leipzig,  1869. 


110  SEXUAL    PAR^ESTHESIA. 

as  his  later  relations  with  females  show.  As  he  says  him- 
self, the  patient  did  not  give  himself  to  men,  in  spite  of  many 
solicitations.  On  the  other  hand,  he  masturbated  in  youth ; 
but  we  have  no  statements  concerning  the  ideas  that  accom- 
panied the  act.  This  case  is  one  of  entire  moral  defect;  it 
was  not  a  desire  for  men  (whose  solicitations  previously,  and 
later  while  in  the  hospital,  he  actively  repelled),  but  merely  his 
desire  for  money  which  induced  him  to  dress  like  a  woman. 
And  it  was  only  after  this,  for  the  sake  of  material  gain,  that  he 
assumed  the  feminine  role,  still,  however,  having  intercourse 
with  prostitutes,  "  who  in  a  drunken  state  accompanied  him 
home."  Besides  this,  he  stated  that  he  once  slept  with  a  cook 
without  touching  her  (]).  Finally  he  became  guilty  of  a  series 
of  thefts. 

Here,  as  Westphal  justly  remarks,  apparently  we  have  to 
do  with  a  weak-minded  individual.  When  arrested  he  was 
suffering  with  gonorrhoea.  In  his  case  the  sexual  element  cer- 
tainly cannot  be  regarded  as  congenital  contrary  sexual  instinct. 
His  preference  for  female  attire  and  his  playing  the  feminine  role 
are  sufficiently  explained  by  the  circumstance  that  he  was  thus 
afforded  a  convenient  source  of  revenue.  Finally,  we  are  not 
constrained  to  believe  every  statement  made  by  a  swindler ;  and 
we  may  remember,  also,  that  deceptions  of  the  imagination 
(pseudologia  phantastica)  occur  in  the  weak-minded.  The 
sexual  feeling  of  the  patient  was  originally  normal ;  in  our 
opinion  it  is  a  case  of  congenital  weak-mindedness  which,  with 
other  symptoms,  but  later,  presented  that  of  contrary  sexual 
inclinations  as  a  result  of  definite  influences. 

Dr.  Schminke1  reports  another  case  of  contrary  sexual  in- 
stinct in  the  .Archiv  fur  Psycliiatrie: — 

This  case  likewise  speaks  more  in  favor  of  the  gradual  development 
of  the  contrary  sexual  phenomena,  with  original  normal  tendency,  on  the 
basis  of  neuropathic  disposition,  than  of  original  predisposition  to  con- 
trary sexual  instinct.  The  patient  had  no  sexual  intercourse  until  his 
twenty  -fourth  year.  He  became  nervously  ill  as  a  result  of  typhus,  and 
in  Paris  he  fell  into  religious  company.  "  Here,  on  one  occasion,  he  was 
sitting  on  a  sofa  with  a  friend,  both  being  in  night-shirts.  Suddenly  he 

1  Archiv  fur  Psychiatric,  Bd.  iii,  Heft  1,  1871,  p.  227. 


HEREDITY    AND    EDUCATION.  171 

was  seized  with  such  a  feeling  of  desire  that  he  embraced  his  friend 
passionately,  and  at  this  instant  he  had  a  pollution."  The  reporter 
says :  "  However,  it  was  remarkable  to  me  that  the  patient  also  immedi- 
ately had  erections  and  slight  emissions  (of  semen  ?)  at  the  sight  of  beau- 
tiful girls  ;  also  when  reading  obscene  books." 

Here  also  the  long-restrained  sexual  impulse  became 
directed  to  the  nearest  object ;  friendly  feelings  and  momentary 
intense  excitement  explain  the  perversion  of  the  otherwise 
normal  instinct.  Both  cases  that  Gock1  contributes  show  that 
the  mental  weakness  upon  which  contrary  sexual  instinct  may 

develop  is  congenital : — 

% 
The  first  case  is  that  of  a  servant-girl  aged  28.     She  comes  of  a 

mother  suffering  with  dementia.  In  school  she  was  frivolous  and  did 
many  foolish  things;  she  masturbated  from  the  time  menstruation 
began  (by  means  of  tactile  or  psychical  excitation).  At  the  same  time 
there  was  awakened  a  preference  for  young  girls  who  attracted  her  by 
the  expression  of  their  eyes.  This  desire  occurred,  as  a  rule,  before  or 
after  the  menses.  When  she  could  kiss  and  embrace  such  a  girl,  she  ex- 
perienced lustful  sensations  in  the  genitals.  If  not  satisfied  in  this  way, 
she  would  think  of  the  girl  and  masturbate. 

She  stated  that,  as  a  child,  she  preferred  boys'  games ;  whether  this 
was  the  case  after  puberty  is  not  stated.  Later,  she  slept  with  girls  and 
touched  their  genitals,  which  gave  her  the  greatest  lustful  pleasure. 
With  repression  of  her  sexual  excitement,  she  several  times  passed  into 
a  state  of  intense  exaltation,  undressed  herself,  and  cried  out ;  she  grew 
quiet,  when  in  bed  with  another  girl,  only  after  gratifying  herself  by 
means  of  onanism.  States  of  excitement  alternated  with  intense  depres- 
sion at  the  time  of  the  menses.  No  feeling  for  men. 

The  first  orgasm  induced  by  onanism  became  associated 
with  the  sense-impression  made  by  persons  of  the  same  sex  that 
happened  to  be  present.  The  irritable  weakness  of  the  psycho- 
sexual  and  genito-spinal  centres,  explainable  by  congenital 
neuropathic  disposition,  made  possible  the  occurrence  of  lustful 
feeling  as  a  result  of  the  reproduction  of  the  idea  of  girls'  eyes. 
The  memory-picture  became  habitual,  and  secondarily  acted 
automatically.  It  then  played  the  role  of  an  imperative  idea, 
and,  owing  to  the  lack  of  inhibitory  opposing  ideas,  the  patient 
became  the  victim  of  a  cerebral  process  that  had  become  inde- 

1  "  Ein  Beitrag  zur  Kenntniss  der  contraren  Sexualempfindung,  aus  der  Wurzburger 
Psychiatr.  Klinik,"  Archiv  fur  Psychiatric,  1875,  Bd.  v,  Heft  2,  p.  564. 


172  SEXUAL    PAR^STHESIA. 

pendent.  The  fancy  elaborated  the  imperative  idea,  and  the 
latter  finally  dominated  the  entire  sexual  existence, — i.e.,  it 
became  determinate  for  the  individual  sexual  excitability. 

Gock's  second  case  illustrates  the  delusion  of  sexual  trans- 
formation, and,  with  the  other  psychopathic  symptoms,  belongs 
entirely  to  the  psychoses. 

We  find  a  further  confirmation  of  our  view  in  the  case 
reported  by  Servaes,1  which  recalls  the  origin  of  contrary  sexual 
instinct  among  the  ancients : — 

Franz  E.  was  misused  for  pederasty  in  his  ninth  year  by  the  tutor 
of  his  friend,  and  from  that  time  was  not  able  to  give  it  up.  Arrest 
on  account  of  suspicion  of  immoral  relations  with  a  night-watchman. 
To  him  carnal  intercourse  with  men  is  the  highest  pleasure  in  the  world. 
Unmitigated  cynicism.  Stole  from  his  room-mates.  Unconquerable 
aversion  for  women.  Onanism.  Exaltation  alternated  with  depression 
until  death.  Female  inclinations.  He  made  ornamental  covers  out  of 
linen.  Increasing  weakness ;  ideas  of  persecution.  Death  due  to 
tuberculosis. 

This  case,  likewise,  does  not  strengthen  the  theory  of 
heredity.  The  fact  that  the  patient  allowed  himself  to  be  used 
for  pederasty  may  be  regarded  as  a  sign  of  lack  of  resistive 
power  dependent  upon  inherited  weak-mindedness.  If,  how- 
ever, we  assume  that  the  case  is  one  of  acquired  contrary 
sexual  instinct,  with  congenital  imbecility,  in  favor  of  which 
the  theft  and  other  peculiarities  speak,  then  it  clearly  demon- 
strates that  the  feminine  character  may  be  the  result  of  the 
assumption  of  the  female  role,  in  the  same  way  that  devotional 
or  theatrical  employment  cultivates  a  certain  type. 

In  the  second  case  reported  by  Servaes,  there  were  maniacal  out- 
breaks alternating  with  states  of  melancholic  depression.  Sexual  incli- 
nations were  manifested  during  the  outbreaks  of  excitement;  she  threw 
herself  on  the  female  nurses  and  overwhelmed  them  with  caresses.  The 
first  evidence  of  menstruation  came  after  the  second  attack.  Maniacal 
excitement,  with  contrary  sexual  instinct  at  the  time  of  puberty.  Re- 
cover}'. 

The  brain,  powerfully  stimulated  "by  indifferent  sensual 
excitants,  convulsively  seeks  for  some  compensation,  and  accepts 

1 "  Zur  Kenntnlss  von  der  contraren  Sexualempflndung,"  Archiv  fur  Psychiatric, 
1876,  Bd.  vi,  Heft  2,  p.  484. 


HEREDITY    AND    EDUCATION.  173 

the  first  person  at  hand.  This  person  is  a  female, — the  more  a 
reason  why  a  girl,  perhaps  unacquainted  with  the  sexual  rela- 
tions, should  trustfully  make  an  approach.  Convulsive  effort 
of  nature  to  complete  sexual  maturity.  The  intensity  of  the 
sensation  attending  the  first  orgasm  may  continue  determinate 
in  weak  and  hereditarily-disposed  brains  ;  but  in  persons  other- 
wise normal  it  becomes  compensated  by  further  normal  develop- 
ment, which  was  the  case  in  this  instance. 

The  following  case,  reported  by  Frankel,1  speaks  still  more 
forcibly  for  the  transformation  of  the  male  into  the  female  type, 
possibly  by  means  of  cultivation,  and  facilitated  by  congenital 
defect  of  resistive  power : — 

The  patient  at  first  bad  assisted  his  mother  in  sewing  and  embroid- 
ering, and  then  became  so  proficient  in  all  kinds  of  feminine  work  that 
he  obtained  a  great  reputation  and  some  return  for  his  embroidery  and 
hanging  of  curtains.  As  a  result  of  his  occupation  in  feminine  work,  he 
gave  himself  to  feminine  vanit}*,  carefully  destroyed  his  beard,  dressed 
his  hair  in  curls,  padded  his  bosom  and  hips,  and  used  every  opportunity 
to  mask  as  a  woman.  What  at  first  was  merely  sill3r  affectation  gradually 
assumed  another  nature  :  the  tone  of  his  voice,  naturally  low,  became 
high  and  shrill  ;  the  gait,  tripping.  Blank  made  application  for  per- 
mission to  dress  as  a  woman,  and,  though  dismissed,  he  one  day  showed 
his  betrothal  to  a  foreign  mechanic  under  the  name  of  "  Friederike  Blank." 
The  patient,  whose  genitals  were  normally  formed,  approached  men  and, 
dressed  like  a  woman,  performed  coitus  with  young  men  whom  he  was 
able  to  deceive  so  skillfully  that  they  thought  they  were  engaged  with  a 
woman.  The  anus  was  much  dilated  and  torn.  When  arrested  he 
killed  himself  by  jumping  into  the  water. 

According  to  these  statements  it  would  seem  that  Blank 
became  feminine  as  a  result  of  his  engagement  in  feminine  pur- 
suits to  which  his  mother  introduced  him.  At  least,  as  West- 
phal  remarks,  it  is  a  case  of  imbecility  and  moral  insanity, 
which  is  also  confirmed  by  other  perverse  inclinations  (theft). 
Why,  in  this  instance,  with  the  demonstration  of  the  influence 
of  training,  contrary  sexual  instinct  must  be  assumed  to  have 
arisen  from  original  disposition  is  not  clear. 

Interesting  and  confirmatory  of  our  view  is  the  report  of 

1  Medic.  Ztg.,  herausgegeben  vora  Vereiu  fur  Heilkunde  in  Preusscii,  Bd.xxii,  1853, 
p.  102 ;  Homo  mollis. 


174  SEXUAL    PAILESTHESIA. 

the  Director  of  the  Penal  Institution  of  Brandenburg,  West- 
phalia, which  is  to  the  effect  that  the  practice  of  feminine 
occupations  by  men  in  the  institution  may  occasion  feminine 
conduct.1 

As  we  have  seen  in  the  cases  reported,  congenital  im- 
becility constitutes  an  important  basis  upon  which,  with  appro- 
priate external  influence,  contrary  sexual  instinct,  with  the 
secondary  phenomena  of  effemination,  may  develop.  In  this 
development  we  see  the  predominance  of  imperative  feelings, 
conceptions,  and  acts.  Further,  states  of  depression  and  ex- 
altation, alternating  periodically,  are  observed.  The  unusual 
intensity  and  the  premature  manifestation  of  the  sexual  instinct, 
resulting  from  hereditary  disposition,  fill  the  fancy  and  drive 
sucli  individuals  to  act  on  the  impulse,  in  which  the  stimulus  of 
the  unusual  may  also  play  a  role.  Always,  however,  after  close 
study  of  the  history,  we  find  how  external  circumstances  exer- 
cise a  determinate  influence  upon  the  form  of  the  perversion. 
If,  however,  in  such  cases  external  influences  seem  to  play  a 
greater  or  as  great  a  part  as  hereditary  predisposition,  still  it 
must  be  allowed,  on  the  other  hand,  that  in  other  cases  the 
original  disposition  is  the  determining  factor.  This  is  true,  for 
example,  of  many  cases  of  lust-murder  (anthropophagy),  viola- 
tion of  corpses,  etc.,  reported  by  von  Krafft-Ebing.  To  a  certain 
extent  algolagnists  constitute  a  transition ;  in  some  cases  patho- 
logical association  seems  to  play  the  principal  part;  in  others 
it  is  not  possible  to  demonstrate  determinate  educational  causes, 
and  the  congenital  disposition  seems  to  exercise  the  principal 
influence.  Thus,  Case  29  of  "  Psychopathia  Sexualis "  favors 
association : — 

An  hereditarily-predisposed  neurasthenic  was  pi-esent  by  accident 
when  his  mother's  servant  cut  her  finger  on  a  broken  pane,  while  wash- 
ing windows.  When  helping  to  stop  the  bleeding,  he  could  not  keep 
from  sucking  up  the  blood  from  the  wound  ;  in  the  act  he  became  vio- 
lently excited  sexually,  experiencing  complete  orgasm  and  ejaculation. 

In  this  case  it  is  quite  possible  that  the  servant-girl  had 
previously  excited  the  boy  sexually,  who  was  given  to  onanism ; 

1  Comp.  Westphal,  loc.  cit. 


HEREDITY    AND    EDUCATION.  175 

and  he  may  have  been  unconscious  of  it.  The  accident  brought 
them  into  bodily  contact.  Violent  erection  and  psychical  onan- 
ism.  The  idea  of  sucking  blood  may  have  been  derived  from 
reading ;  for  such  an  act  is  described  as  customary  after  snake- 
bites and  other  kinds  of  poisoning.  The  patient  became  an 
active  algolagnist. 

In  the  case  reported  by  Moll  (Case  30,  in  "  Psychopathia  Sexu- 
alis  "),  the  patient,  when  a  boy,  read  of  the  abuse  of  Roman  slaves,  and 
the  thoughts  of  whipping  and  subjection  formed  the  content  of  ideas 
accompanying  onanistic  acts.  In  this  way  the  patient  became  a  sadist, 
which,  upon  the  theory  of  pathological  association,  is  easily  explained. 

Acts  of  a  purely  symbolic  nature  with  an  algolagnistic 
purpose,  which  merely  indicate  the  relation  of  subjection,  are, 
as  von  Krafft-Ebing  shows,  fully  explainable  by  pathological 
intensification  of  accompanying  phenomena  of  the  vita  sexualis. 
Very  often  we  find  that  algolagnistic  inclinations  arise  at  the 
sight  of  boys  being  whipped  at  school,  where  accidental  sexual 
excitement  is  associated  with  the  perception  of  the  flogging, 
then  to  become  effectual  in  psychical  onanism,  and,  finally,  to 
become  an  imperative  idea. 

Von  Krafft-Ebing  regards  foot-  and  shoe-  fetichism  as  a 
transitional  form  of  masochism  (passive  algolagny)  to  fetich- 
ism  ;  elements  of  both  anomalies  are  combined  in  it.  And  he 
allows  Binet's  theory  of  association  to  hold  good  for  pure 
fetichism.  The  first  awakening  of  the  sexual  instinct  is  con- 
nected with  a  partial  sexual  impression ;  it  becomes  inde- 
pendent, and  finally  becomes  a  conditio  sine  qua  non  of  sexual 
power ;  and  it  is  then  pathological.  "  The  occasion,"  says 
von  Krafft-Ebing,  "  on  which  the  association  occurred  is,  as  a 
rule,  forgotten."  Therefore,  it  is  clear  that  many  cases  of  the 
autobiographical  kind  are  unable  to  answer  the  question  con- 
cerning the  origin  of  the  anomaly. 

The  significance  of  the  exciting  causes  is  placed  in  the 
clearest  light  by  careful  observation  of  contrary  sexual  indi- 
viduals. 

In  Case  95  of  "  Psychopathia  Sexualis,"  we  have  to  do 
with  lima  S.,  who  is  very  sensual,  but  of  normal  feeling,  made 


176  SEXUAL    PAR^ESTHESIA. 

familiar  by  von  Krafft-Ebing's  "  Experimental  Study  in  the 
Domain  of  Hypnotism."1  To  support  herself  she  donned  male 
attire,  became  a  tutor,  and  finally  gave  up  her  place ;  but  she 
at  last  became  accustomed  to  her  role.  Instinct  and  inclina- 
tion for  the  same  sex,  but  without  transformation  of  character. 

In  Case  72  (mutual  onanism)  and  in  Case  73 2  the  desire 
for  change,  which  came  with  increasing  sexual  decadence, 
became  the  starting-point  of  the  instinct  and  inclination  for  the 
opposite  sex. 

In  Case  72  the  patient  had  been  an  excessive  onanist  since 
his  eleventh  year,  as  a  result  of  seduction.  Nothing  is  said  con- 
cerning the  ideas  accompanying  the  act.  In  a  brothel  he  was 
impotent,  which,  in  my  experience,  may  occur  in  youths  with- 
out perverse  disposition.  Seduced  to  mutual  onanism,  he 
became  contrary  sexually  and  his  character  feminine.  Von 
Krafft-Ebing  correctly  remarks  that  this  is  a  case  of  acquired 
contrary  sexual  instinct. 

In  Case  75  the  first  sexual  excitement  of  the  patient 
(female)  became  connected  in  a  platonic  way  with  a  lady, 
without  any  idea  of  the  sexual  relations.  Marital  intercourse 
compensated  the  instinctive  impulse  entirely,  which  appeared 
again  only  with  abstinence  (widowhood),  and  became  expressed 
in  auto-masturbation.  In  my  opinion,  the  exciting  cause  in 
this  woman,  neuropathic  by  heredity,  was  alone  determinate  for 
her  homo-sexual  inclinations. 

In  Case  76,  the  patient,  T.,  masturbated  from  his  eighth 
year.  What  role  his  fancy  played  in  this — whether  it  conjured 
up  for  him  male  persons  as  a  result  of  accidental  association,  or 
not — he  does  not  say,  though  that  may  have  been  the  starting- 
point  of  his  perversion.  That  the  feminine  inclinations  occurred 
before  the  first  indulgence  in  masturbation  also  seems  question- 
able. 

The  origin  of  the  perversion  in  Case  77  is  very  character- 
istic. A  small  boy  saw  his  sister  change  her  hose.  When  she 

'Translated  by  Chaddock.     G.  P.  Putnam's  Sons,  New  York,  1889. 
"These  numbers  refer  to  cases  in  the  sixth  German  edition  of  Psychopathia  Sexu- 
alis,  and  cannot  be  identified  in  the  English  edition. 


HEREDITY    AND    EDUCATION.  177 

quickly  concealed  her  feet  it  excited  the  boy's  attention  (prob- 
ably the  first  sexual  excitement).  Soon  the  sight  of  her  feet  to 
the  ankles  became  the  object  of  his  desire.  Since  the  sister 
objected,  there  was  soon  a  struggle,  which  the  patient  carried 
on  "  with  all  the  wiles  of  cunning  and  flattery,  even  to  explosions 
of  anger,  until  his  seventeenth  year"  (beginning  of  sadistic  incli- 
nations). Faute  de  mieux,  he  availed  himself  of  the  feet  of 
servants  ;  had  lustful  dreams  about  cutting  corns  and  toe-nails 
(beginning  of  fetichism).  When  the  patient  was  about  13 
years  of  age,  a  comrade,  who  was  sleeping  with  him  in  the 
same  bed,  kicked  at  him  with  his  naked  foot.  The  patient 
seized  the  foot.  Intense  sexual  excitement ;  first  pollution. 
After  that  many  male  persons  excited  the  patient  sexually  (psy- 
chological cause  of  contrary  sexual  instinct).  The  idea  of  a 
girl  getting  a  thorn  in  her  foot  and  its  being  removed  by  a  boy 
gave  him  an  erection  when  a  mere  child.  This  mixture  of 
contrary  sexual,  sadistic,  and  fetichistic  elements  was  compen- 
sated by  normal  sexual  intercourse.  Owing  to  his  lack  of 
resistive  power  in  sexual  relations,  the  patient  became  the 
slave  of  external  influences,  the  quality  of  which  determined 
the  nature  of  the  perversion:  an  excellent  example  of  the 
origin  of  each  of  these  perversions  in  pathological  association. 

In  Case  78  the  contrary  sexual  instinct  was  likewise  ac- 
quired as  a  result  of  mutual  onanism.  Details  will  be  found  in 
the  therapeutic  section. 

The  subject  of  Case  79  was  a  shoe-fetichist  from  his  fourth 
year  (so  stated),  with  contrary  sexual  instinct.  Hetero-sexual 
intercourse  is  possible  with  the  help  of  ideas  of  shoes.  There 
is  no  doubt  of  the  hereditary  predisposition  of  the  patient :  his 
father  is  said  to  have  had  a  preference  for  handsome  lackeys. 
In  this  case,  if  the  perversion  actually  appeared  complete  in  his 
fourth  year,  there  could  be  some  thought  of  original  disposition 
due  to  heredity. 

In  Case  80  the  sexual  instinct  appears  in  the  eighth  year, 
and  becomes  connected  with  (the  nearest  object)  the  sight  of 
his  brother's  genitals.  Mutual  handling  until  the  patient  had 
erection.  Repetition ;  mutual  onanism ;  coitus  inter  femora 


178  SEXUAL    PARyESTHESIA. 

when  13  years  of  age.  Later,  horror  feminse.  After  the  great- 
est difficulty,  coitus  is  finally  performed;  but  it  never  satisfies 
him,  though  the  patient  marries  and  becomes  the  father  of  four 
children.  In  this  case,  likewise,  the  contrary  sexual  instinct  is 
not  necessarily  due  to  original  disposition.  The  sexual  educa- 
tion of  this  man,  wanting  in  resistive  power  because  of  heredi- 
tary taint,  seems  to  us  to  afford  the  explanation :  the  instinctive 
anomaly  rules  too  completely  the  patient's  entire  existence  to 
allow  compensation  by  normal  sexual  intercourse/ 

The  subject  of  Case  81  noticed  the  awakening  of  his  sexual 
instinct  in  his  sixth  or  seventh  year;  at  that  time  he  induced  a 
playmate  of  his  own  age  to  show  him  his  genitals.  Mutual 
handling,  mutual  onanism.  During  the  next  ten  years  unin- 
terrupted sexual  relations  with  friends;  knowledge  came  in  his 
eighteenth  year.  Horror  feminse.  Complete  homo-sexuality. 

In  the  fact  that  children,  as  soon  as  they  become  aware  of 
their  sex,  look  at  their  genitals,  I  can  see  no  indication  of  con- 
genital sexual  perversion,  nor  in  the  curious  handling  of  the 
genitals  of  their  playmates,  that  leads  to  sexual  excitement  and 
mutual  onanism.  In  Case  81,  also,  external  influences  are  suffi- 
cient to  account  for  the  pathological  direction  of  the  instinct ; 
for  systematic  cultivation  could  not  be  more  effectually  prac- 
ticed than  it  was  in  this  case  as  a  consequence  of  unfortunate 
relations. 

In  Case  82,  likewise,  the  sexual  associations,  with  intense 
feelings,  seem  to  have  arisen  accidentally  when  the  patient  was 
in  bed  with  a  companion  (handling  of  the  erected  penis). 

The  subject  of  Case  84  states  that  in  his  third  year  (if 
there  is  not  an  illusion  of  memory)  he  took  an  interest  in  the 
handsome  male  forms  depicted  in  fashion  journals.  Inclinations 
to  play  with  dolls.  From  the  age  of  13  to  15  the  patient  slept 
with  a  man  and  masturbated.  Even  though  this  circumstance 
may  have  given  opportunity  for  pathological  association,  still 
the  patient's  statements  seem,  allowing  that  they  are  correct  for 
the  conditions  existing  before  his  tenth  year,  to  speak  in  favor 
of  original  predisposition. 

In  Case  84,  a  schoolmate,  aged  15,  placed  the.  patient's 


HEREDITY    AND    EDUCATION.  179 

hand  (aged  1 3)  to  his  open  trousers  with  onanistic  intent.  The 
patient's  sexual  feeling,  until  that  time  indifferent,  became  in- 
tensely excited  and  perverted.  From  that  time  his  friendships 
took  on  a  sexual  character.  At  the  age  of  19,  mutual  onanism 
and  development  into  an  urning. 

In  a  similar  manner,  in  Case  85,  this  subject  learns  onanism 
at  the  age  of  6  by  having  his  genitals  handled  by  an  elder  play- 
mate. Enthusiasm  for  handsome  playmates,  desire  to  touch  their 
genitals,  etc.  When  the  patient  came  to  play  with  girls,  his 
impulse  to  onanism  had  already  become  so  powerful  that  no 
compensation  took  place. 

In  the  writer  of  the  autobiography  of  Case  87  the  awak- 
ening of  the  sexual  impulse  occurred  in  his  third  year,  without, 
however,  being  directed  to  the  male  sex.  He  often  sought,  for 
example,  to  look  under  women's  skirts,  to  touch  a  friend's  gen- 
itals, and  to  stroke  the  anus  of  the  coachman's  son.  At  the  age 
of  5,  inclination  toward  a  playmate  (perhaps  induced  by  manip- 
ulations of  the  genitals).  At  14  the  patient  became  a  psycho- 
sexual  hermaphrodite ;  he  loved  young  girls,  but  no  more  than 
he  did  boys.  Then  came  solitary  and  mutual  onanism.  After 
touching  male  genitals  his  ideas  in  sexual  matters  were  about 
persons  of  the  same  sex.  Complete  development  into  an  urning. 

The  writer  of  Case  88  asserts  that  he  has  been  an  urning 
from  the  beginning,  and  doubts  whether  onanism  practiced  from 
youth  could  induce  inversion.  According  to  his  statement,  his 
first  sexual  promptings  occurred  in  his  tenth  year  and  were 
directed  exclusively  to  men.  Onanism  began  in  his  twelfth 
year.  It  is  not  stated  what  external  circumstances  influenced 
the  indifferent  impulse.  If  illusions  of  memory  as  to  the  time 
of  the  first  sexual  excitement  are  not  in  play  here,  this  case  may 
also  be  explained,  in  spite  of  its  defects,  in  the  same  manner  as 
the  preceding. 

The  autobiographer  of  Case  89  experienced  the  first  sexual 
excitement  at  the  age  of  9  or  10,  when  his  tutor  let  him 
"  ride  horse  "  on  his  leg.  The  impulse  then  remained  directed 
to  men.  Whether  the  inclination  for  feminine  pursuits  occurred 
before  or  simultaneously  with  the  excitement  (which  is  the  more 


180  SEXUAL    PAK^ESTHESIA. 

probable)  is  not  stated.  The  impulse  became  confirmed  by 
onanism  with  thoughts  about  men.  Coitus  possible,  but  devoid 
of  satisfaction  ;  successful  only  with  the  help  of  thought  of  men. 

In  Case  90  an  original  disposition  may  be  presumed.  A 
cousin  of  the  patient  is  contrary  sexually,  and  he  states  that  he 
took  the  part  of  a  girl  before  the  occurrence  of  his  sexual  per- 
version. Mutual  onanism  from  his  thirteenth  year. 

The  subject  of  Case  91  (female),  greatly  predisposed,  suf- 
fering with  imperative  ideas,  remains  neutral  sexually  until  her 
twenty-eighth  year,  then  falls  in  love  with  a  lady  five  years 
younger.  Mutual  onanism.  As  in  the  majority  of  cases,  in 
this  instance  the  first  sexual  excitation  exercises  the  most  en- 
during influence  upon  the  patient's  life.  Marriage  and  the 
duties  of  a  mother  later  are  incapable  of  erasing  the  primary 
impression.  She  is  unhappy  in  married  life. 

The  patient  (female)  in  Case  92  shows  signs  of  intense 
sexual  excitement  in  her  thirteenth  year,  which  is  expressed  in 
enthusiastic  love  for  a  friend  of  her  own  age.  By  this  means 
her  sexual  peculiarity  seems  to  liave  been  determined.  Mar- 
riage does  not  cure  her.  She  goes  on  to  inversion  and  probably 
gratifies  herself  in  mutual  onanism.  Nothing  is  said  of  mas- 
turbation from  her  thirteenth  to  her  eighteenth  year. 

This  completes  the  review  of  the  cases  reported  by  von 
Krafft-Ebing  as  congenital  contrary  sexual  instinct  (homo-sexual 
individuals,  or  urnings),  Class  I  (inversion  of  the  sexual  in- 
stinct). From  this  resume  we  see  that  the  influences  of  edu- 
cation, with  two  or  three  exceptions,  can  be  shown  to  have 
exercised  a  determining  effect. 

Neuropathy  or  psychopathy  was  hereditary.  The  few  ex- 
ceptions are  perhaps  to  be  explained  by  imperfect  history  or  the 
self-deception  of  urnings,  which,  according  to  Binswanger's1 
view,  in  "  conscious  "  or  "  unconscious  "  form  is  nowhere  more 
probable  than  in  the  sexual  sphere. 

Not  one  of  the  cases  cited  has  impressed  us  as  if  the 
woman  had  been  developed  db  ovo  in  the  male  body. 

We  come   now  to  the  class  of  "  Effemination  and  Vira- 

1  "  The  Employment  of  Hypnosis  In  Asylums,"  Therap.  Monatsliefte,  Heft  3, 4,  p.  167. 


HEREDITY    AND   EDUCATION.  18^ 

ginity."  Case  93  seems  to  speak  in  favor  of  the  isolated  influ- 
ence of  educational  factors,  for  the  patient's  father  states  that 
the  patient  became  interested  in  female  toilettes,  and  helped  his 
sisters  do  dress-cutting,  etc.  Unfortunately,  we  learn  nothing 
on  the  most  essential  point.  From  the  description  it  is  possible 
that  the  patient's  effemination  was  developed  as  a  result  of 
causes  forgotten, — causes  which  directed  his  sexual  feeling  to 
male  persons.  In  that  case,  his  feminine  employment  may 
have  been  but  a  secondary  accommodation  to  his  assumed  role, 
and  thus  explainable  like  previous  cases. 

The  writer  of  Case  94  did  not  experience  ejaculation  until 
his  twenty-eighth  year,  but  from  his  thirteenth  had  directed  his 
sexual  feeling  to  boys ;  and  his  character  had  developed  into 
that  of  a  woman,  sexually,  without  the  occurrence  of  compen- 
sation of  this  platonic  tendency  by  association  with  women. 
Concerning  the  first  association  the  patient  gives  no  satisfactory 
statements.  It  remains  doubtful,  therefore,  whether  accidental 
cause  or  original  disposition  was  of  greater  influence  in  the  pro- 
duction of  effemination.  In  conclusion,  the  patient  himself 
asks  the  question  whether  this  result  was  not  brought  about  by 
too  great  laxity  of  training. 

The  patient  in  Case  95  makes  such  incomplete  statements 
concerning  the  awakening  and  association  of  his  first  sexual 
excitement  that  we  cannot  use  this  report — which  represents  the 
final  result  of  a  long  process  of  development,  under  the  influ- 
ence of  which  it  is  written — for  our  purpose.  We  learn  only 
that  inclinations  for  men  appeared  in  his  thirteenth  year; 
nothing  is  said  of  onanism. 

The  abnormal  instinctive  tendency  of  the  writer  of  Case 
96,  according  to  the  description,  seems  especially  to  have  arisen 
from  original  disposition.  An  uncle  contrary  sexually;  no 
emission  until  the  twenty-sixth  year ;  no  onanism.  Still,  there 
were  violent  erections  from  the  age  of  13,  which  would  not 
cease,  and  which  ended  with  nightly  pollutions  in  erotic  dreams 
of  male  persons.  Whether,  in  this  instance,  the  original  sexual 
neutrality  was  given  a  perverse  direction  toward  men  by  ex- 
ternal circumstances,  and  thus  the  imagination  became  occupied 


182  SEXUAL    PAR^ESTHESIA. 

in  the  same  way,  remains  doubtful.  In  such  case  the  effemi- 
nation  was  here  also  to  be  attributed  solely  as  a  result.  As  far 
back  as  the  patient  could  remember,  his  development  of  char- 
acter had  been  feminine. 

Count  Z.,  subject  of  Case  97,  began  masturbation  at  the 
age  of  11,  and  during  that  year,  in  church,  a  man  made  a  fasci- 
nating impression  on  him.  At  the  age  of  13,  neurasthenia 
spinalis  and  inclinations  toward  men.  Preference  for  dolls  and 
girls'  games.  Horror  feminse.  Great  hereditary  taint. 

Two  sisters  of  the  patient  who  is  the  subject  of  Case  98 
love  men.  At  the  age  of  13  the  patient  was  seized  with  a 
passionate  love  for  an  elderly  officer.  He  remained  true  to  his 
perversion  after  this  incident.  Onanism  and  impotence  with 
women.  In  this  instance,  also,  the  possibility  of  cultivation  does 
not  seem  to  me  to  be  excluded. 

If  it  be  possible  to  defend  original  disposition  in  the  two 
cases  last  mentioned,  it  does  not  seem  possible  in  Case  99.  The 
patient  felt  his  sexual  instinct  awaken  in  his  eighth  year,  and 
had  the  idea  penem  aliorum  puerorum  in  os  arrigere,  to  which 
he  may  have  been  brought  by  circumstances  that  are  not  men- 
tioned. Great  pleasure,  and  determination  of  his  feeling  toward 
men.  Later,  he  was  able  to  perform  coitus,  and  he  became  the 
father  of  two  children.  The  effemination  seems  to  have  been 
developed  secondarily.  Educational  influences  operating  upon 
one  hereditarily  predisposed  may  here  be  taken  as  offering  an 
explanation. 

The  subject  of  Case  100  found,  as  early  as  at  the  age  of  5, 
his  greatest  pleasure  in  seeing  a  penis,  and  for  this  purpose  he 
lounged  about  appropriate  places.  Onanism  before  puberty. 
In  this  case,  apparently,  circumstances  not  mentioned  must 
have  turned  the  boy's  attention  to  the  penis  (exactly  as  in  the 
case  of  one  of  my  patients).  Later,  love  of  friends ;  sexual 
intercourse  with  men ;  effemination,  in  spite  of  complete  devel- 
opment of  the  male  sexual  character  (beard  and  voice). 

Cases  101  and  102  contain  only  notes  without  etiological 
points.  The  last  case  of  this  class,  Case  103,  is  that  of  a 
servant-girl  afflicted  with  original  paranoia  and  hysteria,  who 


HEREDITY   AND   EDUCATION.  183 

never  had  felt  inclination  for  men,  but  for  female  friends. 
Enthusiastic  love  for  persons  of  her  own  sex  from  the  time  of 
puberty.  The  report  contains  no  more  detailed  description  of 
the  origin  of  the  sexual  perversion  ;  so  that  the  question  whether 
the  original  disposition  or  educational  influence  was  more  largely 
responsible  for  the  origin  of  gynandry  must  remain  open. 

As  we  have  seen  from  the  foregoing  review,  there  has  been 
-no  absolute  proof  in  any  case  of  the  origin  of  contrary  sexual 
inclinations  and  effemination  with  exclusion  of  the  influence  of 
training.  Even  the  doubtful  cases  could  possibly  be  explained, 
on  closer  examination  of  the  pathological  association  of  the 
first  sexual  excitement  and  the  person  immediately  at  hand. 
In  every  instance  we  find  inability  to  overcome,  by  opposing 
ideas  and  normal  sexual  intercourse,  the  confirmed  perversion 
(as  a  rule,  by  onanism  with  corresponding  dream-pollutions)  that 
has  arisen  as  a  result  of  some  accidental  impression, — a  weak- 
ness that  is  to  be  ascribed  to  the  hereditary  predisposition,  as  is 
the  premature  awakening  of  the  sexual  instinct  which  is  in  these 
patients. 

In  his  "  Psychopathia  Sexualis,"  von  Krafft-Ebing  gives 
three  cases  of  gynandry  and  androgyny. 

The  subject  of  Case  104  is  a  person  defective  db  origine, 
affected  with  neurasthenia  spinalis,  which  is  ascribed  to  the 
causal  influence  of  masturbation.  At  the  age  of  22  the  patient 
associates  with  women,  performs  coitus  normally,  but,  owing 
to  imperfect  satisfaction,  he  turns  away  from  the  female  sex. 
Thorax  and  pelvis  of  feminine  form ;  slight  growth  of  hair  on 
the  mons  veneris,  which  is  prominent  and  plump.  Voice  high, 
without  masculine  timbre.  Patient  is  neuropathic  in  such  a  way 
that  the  sexual  perversion  represents  but  a  partial  symptom  of 
his  condition.  It  seems  to  arise  from  abnormal  organic  conditions. 

The  patient  (female)  in  Case  105,  aside  from  masculine 
manner,  presents  coarse  features  and  a  rough,  deep  voice.  Bosom 
and  pelvis  feminine.  She  grew  up  with  a  preference  for  mascu- 
line pursuits,  but  there  are  no  other  details  given  of  educational 
influences.  Corresponding  with  her  ?*o/e,  she  feels  like  a  man, 
and  later  becomes  associated  with  women. 


184  SEXUAL    PAR^STHESlA. 

It  seems  to  me  questionable  whether  the  few  physical 
signs  (voice  and  coarse  features)  alone  justify  the  assumption  of 
gynandry  in  the  presence  of  a  type  otherwise  feminine.  It 
would  be  interesting  to  know  how  the  patient  came  to  assume 
the  masculine  role.  The  history  of  the  case  does  not  deny  the 
possibility  that  the  inversion  of  sexual  feeling  was  brought 
about  by  educational  influences. 

The  subject  of  the  last  detailed  description  (Case  106)  is 
the  notorious  Count  Sandor  S. ;  in  reality,  Countess  Sarolta  V. 
The  details  of  this  history  are  too  well  known  to  require  repe- 
tition here.  The  physical  signs  indicative  of  gynandry  in  the 
patient,  according  to  Birnbacher,  are  :  (a)  general  narrowing 
of  the  diameters  of  the  pelvis,  which  is  of  the  male  type; 
(b)  straight  thighs,  infantile  female  genitals,  trunk  devoid  of 
waist,  voice  deep  and  rough,  breast  fairly  developed. 

The  opinion  of  Dr.  Birnbacher  and  Dr.  Josch  was  to  the 
effect  that  Countess  V.  was  suffering  with  congenital  neuras- 
thenia, congenital  mental  disease  in  the  nature  of  elementary 
disturbance  of  mental  function,  and  contrary  sexual  instinct 
depending  upon  the  same  basis ;  and  that  therefore  she  was  to 
be  regarded  as  insane. 

In  a  supplementary  statement  the  same  authors  state  that 
the  acts  related  to  the  sexual  instinct  arose  from  a  kind  of 
organic  necessity  which  recalls  the  so-called  imperative  acts  of 
certain  insane  patients. 

The  opinion  given  in  the  higher  court  by  the  faculty  of 
Vienna,  signed  by  Theodor  Meynert1  as  referee,  declares  that 
the  patient  is  irresponsible,  but  contains  another  view  of  the 
disease.  The  facial  bones,  the  position  of  the  teeth,  and  the 
pelvis  are  called  rachitic.  "Owing  to  the  father's  influence  she 
was  early  educated  as  a  boy,  and,  as  a  result  of  this,  deprived  of 
the  educational  influences  of  an  ethical  orientation  of  the  simplest 
things  connected  with  her  station  in  life  and  her  duties  to  her 
fellow-beings.  .  .  .  Carried  away  with  poetical  fancies,  she 
gave  herself  the  form  of  a  man  dressed  in  her  boys'  garments, 
like  Don  Juan.  Besides  male  garments,  her  conduct  was  allowed 

1  Comp.  Friedreich's  Blatter  fur  gericht.  Medicin.,  Nurnberg,  1891,  Heft  1,  p.  36. 


HEREDITY    AND    EDUCATION.  185 

to  be  unrestrained, — the  very  opposite  of  a  girl's  education." 
Sexual  feeling  at  the  age  of  12,  which,  corresponding  with  her 
early  preparation,  found  its  first  satisfaction  in  contact  with  a 
young  English  school-girl.  Thereafter,  comradeship  with  males. 
Relations  with  women,  while  men  were  indifferent  Drinking, 
smoking,  night-carousals,  etc.  "  By  using  a  glove  a  penis  was 
imitated.  She  retired  behind  trees  to  give  the  impression  of 
urinating  like  a  man ;  said  her  menstruation  was  due  to  haem- 
orrhoids, etc.  She  once  stated  that  she  had  to  engage  in  mili- 
tary drill,  and  said  she  had  a  scar  on  her  arm  from  a  wound 
received  in  a  duel."  The  referee  opposes  the  theory  of  congen- 
ital masculinity  with  female  genitals,  and  emphasizes  that  the 
countess  is  practiced  in  the  imitation  of  masculinity ;  that 
doubtless  she  directs  the  tone  of  her  voice  accordingly;  that 
she  imitates  masculine  immorality,  and  "overdoes  the  matter." 

The  fact  of  growing  up  in  male  attire  is  not  given  suffi- 
cient weight  by  the  experts.  According  to  this  view.  Countess 
Sarolta  V.  suffers  with  imbecility  with  excitement,  and,  owing 
to  her  weak-mindedness,  she  is  unable  to  judge  her  own  acts, 
etc. 

"  In  combination  with  other  excesses — tricks,  absolute  social 
looseness,  prevarication,  drunkenness — the  symptom  of  contrary 
sexual  instinct  constitutes  the  patient's  degeneracy,  for  which 
the  name  '  moral  insanity '  is  largely  in  use.  The  latter  is  but  a 
symptom  of  congenital  imbecility." 

The  occurrence  of  Westphal's  contrary  sexual  instinct 
Meynert  holds  always  to  be  accidental.  The  sex  with  which 
early  sexual  impressions  happen  tc  become  connected,  in  abnor- 
mal individuals,  determines  the  occurrence  of  this  symptom. 
Imitation  and  education  develop  all  the  ultimate  characteristics 
of  the  sexes.  At  any  rate,  and  we  agree  with  Meynert  in  this, 
this  case  is  very  instructive  as  showing  the  exciting  cause  of 
contrary  sexual  instinct. 

The  remaining  cases  of  contrary  sexual  instinct  reported 
in  "Psychopathia  Sexualis "  are  concerned  with  therapeutics, 
and  are  considered  in  the  therapeutic  part  of  this  section. 

The  foregoing  critical  review  with  respect  to  the  influence 


186  SEXUAL    PAR.ESTHESIA. 

of  education  is  sufficient  to  confirm  our  theoretical  propositions 
concerning  sexual  development ;  and,  therefore,  for  the  sake  of 
brevity  as  well,  it  does  not  seem  necessary  to  extend  this  exam- 
ination to  cases  in  von  Krafft-Ebing's  "  New  Investigations  in 
Psychopathia  Sexualis." 

While,  as  we  have  seen,  in  the  cases  given  in  "  Psycho- 
pathia Sexualis,"  the  principal  emphasis  is  laid  upon  the  origi- 
nal disposition  dependent  upon  hereditary  influences,  some  of 
the  reports  of  perverse  sexual  instinct  made  by  Hammond  are 
instructive  for  us,  owing  to  the  consideration  of  the  exciting 
causes.  At  least,  Hammond1  points  out  that  in  cases  in  which 
individuals  entertain  the  delusion  that  they  belong  to  the  oppo- 
site sex  (vide  von  Krafft-Ebing's  "  delusions  of  sexual  transfor- 
mation"2) are  not  to  be  confounded  with  cases  of  this  kind,  "  for 
they  are  cases  of  actual  monomania,  and  are  seldom  combined 
with  other  pathological  sexual  symptoms." 

The  importance  which  educational  factors  and  external 
influences  may  attain  in  the  origin  of  sexual  perversions,  as  a 
result  of  pathological  associations  in  the  case  of  hereditary 
neuropaths,  is  illustrated  by  the  following  cases,  reported  by 
Hammond : — 

A  bo}',  aged  7  years,  who  was  hereditarily  predisposed,  was  taught 
to  masturbate  by  a  servant-girl.  At  first  she  induced  erection  by  touch- 
ing his  penis  with  her  foot  with  the  shoe  on,  and  thus  the  patient  experi- 
enced his  first  sexual  pleasure.  From  that  time  sexual  excitement  and 
erections  at  the  sight  of  women's  shoes  ;  later,  at  the  mere  thought  of 
them.  Onanism  iu  the  midst  of  women's  shoes,  which  he  placed  about 
himself  in  all  sorts  of  positions.  Then  psychical  onanism  by  means  of 
the  thought  of  women's  shoes.  At  school,  sexual  excitement  due  to  the 
teacher's  shoes.  Partial  concealment  of  the  shoes  by  long  skirts  induced 
especial  pleasure.  In  order  to  intensify  his  sensual  excitement  he  one 
day  seized  his  teacher's  shoe,  and  experienced  greater  pleasure  than  ever. 
Sexual  orgasm.  In  spite  of  punishment,  repetition  of  the  act,  with  like 
result.  Later,  the  mere  memory  of  his  teacher's  shoe  induced  ejacula- 
tion. After  that  he  purloined  the  servant-girl's  shoe  and  ejaculated  in  it. 
New  variations  by  using  a  different  shoe  with  each  act  of  onanism.  He 
stole  shoes  for  this  purpose.  Nude  women  or  men  excited  only  feel- 
ings of  disgust.  He  never  thought  of  sexual  intercourse.  Finally,  he 

1  Loc.  cit. 

8  Krafft-Ebing's  "  New  Investigations  "  gives  very  pregnant  examples. 


HEREDITY    AND   EDUCATION.  187 

sold  shoes  in  a  store.  Sexual  excitement  while  fitting  them.  On  one 
occasion,  while  fitting  a  pair  of  shoes,  powerful  erection  without  orgasm  ; 
loss  of  consciousness  and  an  epileptic  attack.  Determination  to  marry. 
Impotence  in  marriage.  On  Hammond's  advice  he  hung  a  shoe  over  his 
head  ;  simultaneous  treatment  with  bromides.  Coitus  was  then  success- 
ful, and  without  epileptic  attack.  Later,  regular  sexual  intercourse  once 
in  ten  days.  The  thoughts  of  women's  shoes  came  to  him  still  now  and 
then,  but  without  exciting  him  sexually. 

This  very  remarkable  case,  as  Hammond  remarks,  shows 
that  a  strong  will,  even  in  a  man  of  no  great  intelligence,  is 
capable  of  redirecting  an  abnormal  instinct  into  its  normal  path. 

Another  of  Hammond's  patients,  a  cigar-dealer,  in  childhood  saw 
a  dog  and  bitch  copulate.  Believing  that  this  took  place  by  means  of 
the  anus,  he  passed  a  lead-pencil  into  his  own  rectum.  "  This  caused 
him  local  pain,  but  also  a  peculiar  feeling  of  pleasure,  the  localization 
of  which  he  could  not  at  first  make  out."  After  a  few  days  he  repeated 
the  experiment  with  similar  result,  but  this  time  used  the  handle  of  a 
tooth-brush  which  he  had  previously  oiled  well.  Again  he  experienced 
a  pleasurable  feeling,  and  that  in  the  penis.  From  this  passive  pederasty 

was  developed. 

«• 

Moll,1  who  "  will  not  deny  that  accidental  causes  are  not 
without  value,"  assumes  that  there  was  doubtless  an  abnormal 
disposition  in  the  boy.  "  How  could  he,"  asks  Moll,  "  otherwise 
have  had  such  a  pleasurable  feeling  on  inserting  the  lead-pencil 
in  his  anus  as  to  be  led  to  repeat  it  so  frequently1?  "  Even  if 
the  patient  were  the  subject  of  an  inherited  neuropathic  dispo- 
sition, which  Hammond's  report  does  not  make  clear,  it  would 
not  be  necessary  to  regard  it  as  an  original  inclination  to 
pederasty.  Local  irritation  of  the  rectum  alone  is  sufficient  to 
induce  erection,  and  therefore  causes  sexual  excitement,  as  has 
been  repeatedly  demonstrated  on  impotent  debauchees  in  re- 
moving foreign  bodies  from  the  rectum. 

From  pederasty  contrary  sexual  instinct  was  developed  in 
the  patient ;  he  put  on  feminine  attire,  called  himself  "  Lida," 
and  never  had  inclination  for  women  after  the  undifferentiated 
sexual  feeling  had  been  given  a  definite  direction.  He  later 
had  epileptiform  attacks.  He  stated  that  he  had  performed 
pederasty  at  least  ten  thousand  times,  actively  and  passively. 

1  Loc.  cit.,  p.  163. 


188  SEXUAL    PAR^STHESIA. 

The  desire  to  be  a  woman  became  so  intense  (as  in  the  pathici 
of  the  ancients  and  in  some  of  von  Krafft-Ebing's  patients)  that 
he  repeatedly  thought  of  amputating  his  genitals. 

In  the  following  case,  by  Hammond,  accidental  local  irri- 
tation (of  erogenous  areas)  seems  to  have  been  the  starting- 
point  of  the  perversion: — 

A  boy,  aged  12,  was  severely  punished  in  school  for  a  mischievous 
prank  ;  soon  after  he  had  an  erection  lasting  half  an  hour,  with  a  peculiar 
feeling  in  the  glans  which  he  had  never  before  experienced.  The  same 
afternoon  he  went  bathing  with  a  companion,  and  while  in  the  water  he 
placed  his  hands  on  his  companion's  shoulders.  He  had  often  done  this 
before  without  experiencing  sexual  excitement.  On  this  occasion  his 
penis  touched  his  friend's  gluteal  region,  and  immediately  he  experienced 
the  same  feeling  with  erection  that  he  had  had  after  being  punished. 
They  were  near  the  bank,  and,  without  being  conscious  of  it,  he  performed 
pederasty  (immissio  penis  in  anum?).  From  this  time  he  continued  the 
vice,  partly  passively,  but  for  the  most  part  actively  by  preference. 
Sexual  excitement  induced  by  nude  men  ;  onanism.  Ideas:  male  gluteal 
region;  di'eam-pollutions  of  a  pederastic  nature.  Women  had  no  power 
to  excite  him.  %He  remained  an  active  pederast. 

Hammond's  treatment  freed  him  entirely  of  his  perverse  tendencies. 
It  consisted  of  "  study  of  mathematics,  hydrotherapy  ;  cauterization  of 
the  cervical,  dorsal,  and  lumbar  regions  ;  bromides,  and  family  social  life." 
After  a  few  months  essentially  improved  ;  sexual  inclinations  for  women  ; 
marriage. 

The  following  case  is  also  interesting,  though  in  some 
respects  it  seems  to  speak  in  favor  of  the  theory  of  original 
predisposition : — 

The  patient,  father  of  four  healthy  children,  the  issue  of  an  ex- 
tremely happy  marriage,  according  to  his  own  statements,  before  pubert}' 
had  a  decided  preference  for  household  work  and  feminine  games  and 
dress,  though  he  came  only  to  wear  girls'  shoes.  His  preference  for 
feminine  attire  grew  later,  as  well  as  that  for  acting  feminine  roles  on 
the  stage  by  men.  At  the  age  of  21  he  wore  corsets,  laced  himself, 
and  stated  that  he  thus  experienced  great  sensual  satisfaction.  No 
onanism,  but  involuntary  ejaculation  three  times  while  putting  on  and 
buttoning  a  pair  of  very  tight  slices  (ladies'  shoes  with  French  heels). 
After  his  marriage  he  no  longer  wore  corsets. 

In  spite  of  a  happy  marriage,  after  several  years  the  same  ideas  re- 
turned. He  was  accustomed  to  put  on  and  button  ladies'  high-heeled 
shoes,  which  induced  erection  and  ejaculation.  Ideal  cohabitation  at  the 


HEREDITY   AND   EDUCATION.  189 

sight  of  a  lady  tightly  laced  and  with  elegant  feet.  Again  he  wore  cor- 
sets, and,  to  increase  the  pleasure  by  novelty,  he  bought  other  articles 
of  feminine  apparel, — a  black-silk  gown,  curls,  hoops,  false  hair,  and  ear- 
rings. He  padded  his  breasts,  laced,  and  put  on  an  enormous  bustle. 
He  had  his  hair  dressed  fantastically  in  the  ladies'  fashion  for  hours  at  a 
time.  He  persuaded  his  wife  to  lace.  He  dressed  himself  up  as  a  ballet- 
dancer,  Queen  Elizabeth,  a  Polish  lady,  an  old  maid,  the  Goddess  of 
Liberty,  Julia,  etc. 

In  this  very  interesting  case,  unfortunately,  we  learn  noth- 
ing of  the  manner  of  origin  of  the  pathological  association, — 
that  is,  nothing  of  the  external  circumstances  which  were  oper- 
ative in  inducing  the  preference  for  feminine  dress.  In  this  case, 
as  was  remarked  in  opposition  to  WestphaPs  view,  in  our  opinion, 
we  are  not  concerned  with  a  case  of  contrary  sexual  instinct, 
for  the  sexual  feeling,  as  the  happy  marriage  and  the  four  chil- 
dren show,  was  perfectly  normal,  and  underwent  no  essential 
alteration  as  a  result  of  the  imperative  ideas.  At  most,  the 
case  might  be  called  one  of  psycho-sexual  hermaphroditism.  In 
spite  of  the  feminine  role  and  the  erotic  fetichism,  the  sexual 
feeling  remained  normal,  and  the  imperative  idea  only  concerned 
dress.  Had  the  patient  masturbated  excessively,  and  thus  in- 
tensified his  perverse  tendencies,  he  might  possibly  have  come 
to  assume  also  the  feminine  sexual  role.  This  case  shows  clearly 
that  we  are  justified  in  speaking  of  contrary  sexual  instinct  only 
when  the  sexual  feeling  is  demon strably  implicated.  Subsidiary 
symptoms,  like  preference  for  ornament  and  feminine  work,  or 
specific  feminine  peculiarities  of  character,  are  not  by  themselves 
sufficient  to  justify  a  diagnosis  of  sexual  inversion,  though  they 
may  easily  become  the  starting-point  of  it,  for  proof  of  which, 
in  the  foregoing  case,  the  erections  and  ejaculations  may  be 
noted. 

How  very  influential  external  circumstances  are  in  deter- 
mining the  sexual  character  is  shown  by  the  following  case, 
reported  by  Rouboud * : — 

A  general's  son,  while  a  pupil  at  a  military  school,  at  the  age  of  14 
was  introduced  to  the  pleasures  of  love  by  a  young  lady,  a  friend  of  the 

1  Rouboud  :  Traite  de  1'impuissance  et  de  la  st6rilit6,  3  6d.,  Paris,  1876 ;  and  Ham- 
mond, loc.  cit. 


190  SEXUAL    PAR^STHESIA. 

family.  This  lady,  then  21,  was  a  blonde,  wearing  her  hair  in  the 
English  fashion, — in  twisted  locks;  and,  to  avoid  detection,  she  had 
sexual  intercourse  with  her  young  lover  only  while  dressed  in  her  usual 
garments, — skirts,  corsets,  and  a  silk  gown.  All  these  peculiarities 
finally  had  the  greatest  influence  not  only  oil  the  intensity  of  excite- 
ment, but  also  merely  on  its  occurrence.  This  exceedingly  sensual 
young  lady  exhausted  the  boy's  strength,  and  only  the  strict  discipline 
of  the  military  school  was  capable  of  restoring  the  sexual  organs,  which 
had  been  overstimulated  by  too  early  and  too  frequent  use.  Finally, 
after  leaving  the  school,  the  patient  noticed  that  his  sexual  desire  could 
be  excited  only  under  definite  conditions, — by  certain  women.  A  bru- 
nette could  not  excite  him ;  a  female  in  night-costume  might  stifle  all 
desire  in  him.  In  order  to  excite  his  desire,  the  woman  had  to  be  a 
blonde,  and  wear  skirts,  a  corset,  and  a  silk-dress;  in  short,  be  dressed 
like  the  woman  who  had  first  excited  him  sexually. 

Similar  pathological  associations  may  so  operate  as  to 
render  a  husband  virile  only  with  his  wife,  or  to  make  a 
debauchee  impotent  on  his  marriage-night.  This  relative 
impotence  is  due  to  one-sided  determination  of  sexual  feeling 
which,  in  many  instances,  has  previously  been  undetermined, 
and  it  may  attain  the  intensity  of  imperative  feelings.  Psycho- 
logically, it  is  to  be  explained  like  the  pathological  association  of 
fetichism  and  the  impotence  of  persons  of  contrary  sexuality. 

Concluding  Remarks. — A  review  of  the  cases  already 
given,  and  of  those  still  to  be  given  in  the  therapeutic  portion 
of  this  work,  clearly  shows  the  extraordinary  importance  of 
accidental  factors  of  education  and  external  influences  in  the 
etiology  of  paraesthesia  sexualis, — a  fact  which,  I  think,  is 
greatly  undervalued  by  some  authors. 

We  have  seen  that  many  cases  that  have  been  regarded  by 
their  reporters  as  abnormality  of  hereditary  disposition  were 
developed  as  a  result  of  accessory  causes ;  that  the  proof  of  the 
existence  of  a  congenital  predisposition,  such  as  that  of  the 
female  type  of  character  in  a  male  body,  for  example,  rests 
entirely  upon  statements  made  by  patients,  and  therefore  is 
defective.  The  historical  and  developmental  theory  of  anthro- 
pological transformation  (androgyny  and  gynandry)  seems  to  us 
least  entitled  to  support  by  experience. 

On  the  other  hand,  as  a  rule,  pathological  association  was 


HEREDITY   AND   EDUCATION.  191 

capable  of  developing  the  evil  results  only  where  a  nervous 
system  of  slight  resistive  power — the  most  frequent  symptom 
of  hereditary  taint — offered  favorable  ground.  The  experiences 
with  fetichists  taught  us,  first  of  all,  what  part  may  be  played 
by  the  object  of  the  perversion,  in  determining  its  form  as  a 
cause  of  imperative  ideas  and  feelings  with  their  consequences 
(effemination,  for  example). 

The  part  played  by  the  accessory  factor  in  the  etiology  of 
the  habitual  impulse  to  perverse  sexual  acts  is  usually  more 
important  than  that  played  by  hereditary  disposition.  And  the 
latter,  in  the  class  of  psycho-sexual  anomalies  we  have  consid- 
ered, and  which,  in  comparison  with  those  resulting  from  demon- 
strable original  brain  constitution,  includes  the  larger  number 
of  cases,  represents  a  general  pathological  disposition  (imbecility 
or  irritable  weakness),  and  a  want  of  resistive  power  to  com- 
pensate the  pathogenetic  excitations  by  normal  opposing  con- 
cepts or  inhibition  of  impulse.  With  this,  I  think,  we  have 
reached  a  more  general  and  a  clearer  conception  of  a  large  class 
of  psycho-sexual  disturbances  and  diseases,  more  satisfactory 
with  reference  to  prognosis  and  therapeutics. 


CHAPTER  X. 
DIAGNOSIS  AND   PROGNOSIS. 

Remarks  on  Perverse  Activity,  Original  Disposition,  Ac- 
cessory Causes,  and  Neuropathic  and  Psychopathic  Symptoms. 
— Diagnosis  in  the  case  of  fetichists  and  algolagnists  is  rela- 
tively easier  than  in  the  case  of  contrary  sexuality ;  for,  as  a 
rule,  their  sexual  power  is  associated  with  the  perverse  activity 
of  the  instinct,  and  normal  intercourse  is  impossible.  There  are 
some  exceptions  to  this.  Perverse  activity  is  to  he  regarded  as 
pathological  in  every  case  where  it  is  a  conditio  sine  qua  non  of 
sexual  power. 

In  algolagny,  as  pointed  out  in  the  foregoing  chapter,  it 
must  be  ascertained  whether  the  acts  expressing  cruelty  are 
active  or  passive  in  nature ;  also,  when  they  are  merely  sym- 
bolic, whether  they  signify  subjection. 

Too,  the  abnormal  manifestations  of  the  sexual  instinct 
largely  arise  from  pathological  intensification  of  the  inclination, 
very  common  in  healthy  men,  to  experience  variations  in  the 
sexual  relations.  In  such  cases  the  object  and  the  manner  of 
the  perverse  activity  change ;  the  object  of  it  may  belong  to 
both  sexes. 

In  all  perversions,  uranism  as  well  as  fetichism  and  algo- 
lagny, the  question  of  hereditary  taint,  as  shown  by  our  con- 
siderations, must  be  studied  most  carefully.  Therefore  the 
following  question  is  of  the  utmost  importance.  Is  the  perver- 
sion the  result  of  an  original  abnormality  of  cerebral  constitu- 
tion, or  has  it  developed  as  a  result  of  accessory  injurious 
influences  of  education  upon  the  predisposing  basis  of  a  neuro- 
pathic hereditary  taint  I 

Too,  the  states  of  original  degeneration  may  become  de- 
veloped only  in  the  course  of  life  from  the  inherited  dis- 
position. In  order  to  form  a  judgment  of  the  "plastic 
capability  of  adequate  adaptation  to  external  circumstances" 
(Forel),  the  most  exact  knowledge  of  the  accidental  influences 
(192) 


DIAGNOSIS   AND   PROGNOSIS.  193 

of  education  is  necessary.  The  occurrence  of  the  first  sexual 
excitement  (indefinite  feelings  and  erection),  which  may,  as  we 
have  seen,  take  place  as  early  as  from  the  fifth  to  the  eighth 
year,  especially  in  those  hereditarily  predisposed ;  the  external 
circumstances  accompanying  it,  which  often  lead  to  the  fatal 
association ;  further,  the  occurrence  of  the  first  sexual  orgasm 
with  its  associated  perceptions ;  and,  finally,  the  ethical  and 
emotional  reactions, — all  are  of  the  greatest  importance.  Where, 
however,  in  spite  of  all  favorable  educational  influences,  and 
without  demonstrable  external  causes,  the  perversion  progres- 
sively develops,  congenital  disposition  seems  to  bring  about  the 
result.  Still,  it  must  be  remembered  that  the  exciting  causes 
are  often  forgotten.  The  idea  accompanying  the  onanistic  act 
(whether  psychical  or  mechanical)  should  be  studied,  for  by 
practice  and  habit  the  abnormal  thought  may  become  an 
imperative  idea. 

But  the  absence  of  onanism  does  not  exclude  cultivation. 
For  the  fancies  accompanying  dream-pollutions  are  likewise 
merely  recapitulations  of  the  individual's  experience.  If,  in 
their  first  sexual  association,  these  are  of  a  perverse  nature, 
they  may  then  assume  the  role  of  cultivation. 

Such  cases,  also,  as  those  in  which  no  hetero-sexual  rudi- 
ments of  any  kind  can  be  discovered  are  by  no  means  decisive 
as  evidence  of  the  original  character  of  contrary  sexual  instinct ; 
they  may  likewise  be  the  result  of  external  influences  which, 
from  the  first  perverse  association,  completely  appropriated  the 
undifferentiated  sexual  feeling,  and  thus  left  no  opportunity  for 
other  sexual  feelings  and  experiences. 

On  the  other  hand,  very  important  in  establishing  the 
original  tendency  of  contrary  sexual  instinct  is  the  proof  that 
the  feminine  .characteristics  of  the  male  child  were  developed 
before  the  occurrence  of  the  first  sexual  excitement  (not  before 
puberty,  as  many  urnings  think),  and  that  feminine  sexual  feeling 
arose  from  these  characteristics  without  the  aid  of  external  in- 
fluences. On  this  point,  however,  the  statements  of  urnings — 
their  confessions — are  to  be  accepted  only  with  great  reserve. 
For,  while  writing  the  autobiography,  these  individuals  are  under 


194  SEXUAL    PAR^ESTHESIA. 

the  subjective  influence  of  a  sexual  development  resting  upon 
numerous  experiences ;  perhaps,  too,  they  are  subject  to  the 
unconscious  suggestion  of  von  Krafft-Ebing's  theory  of  hered- 
ity, and  thus  enlarge  the  history  retrospectively,  without  distinc- 
tion in  time  of  the  subjective  events.1  On  this  point,  no  error 
is  easier  than  to  date  the  beginning  of  effemination  before  the 
time  of  the  first  sexual  excitement ;  while  effemination  as  a  sec- 
ondary product  of  sexual  inversion  would  speak  in  favor  of  the 
theory  of  cultivation.  Standing  alone,  without  sexual  inversion, 
manifestations  of  efFemination  prove  the  existence  of  contrary 
sexual  instinct  as  little  as  do  physical  peculiarities  which  resemble 
those  of  women. 

We  may  distinguish  three  possible  etiological  develop- 
mental factors  in  the  production  of  contrary  sexual  instinct : 
(1)  original  cerebral  constitution  ;  (2)  a  neuropathic  disposition 
with  educational  influences  ;  (3)  pure  cultivation  in  normal  in- 
dividuals. Class  2  is  by  far  the  most  numerous. 

In  sexual  inversion  the  following  important  diagnostic 
points  should  be  considered:  (a)  the  episodical  occurrence  of 
homo-sexual  impulses  in  individuals  of  hetero-sexuality ;  (6) 
psycho-sexual  hermaphroditism ;  (c)  the  content  of  sexual 
dreams ;  (df)  the  complete  absence  of  hetero-sexuality  as  a 
pathological  phenomenon  (Moll). 

It  is  of  the  greatest  importance  in  diagnosis  to  demonstrate 
the  existence  of  other  neuropathic  or  psychopathic  symptoms, 
signs  of  degeneracy,  etc. ;  that  is,  to  ascertain  whether  the  per- 
version occurs  as  a  symptom  of  moral  insanity,  congenital  im- 
becility, etc.,  or  whether  the  disturbance  of  the  sexual  instinct 
seems  to  be  isolated  and  independent  in  an  individual  otherwise 
normal  mentally. 

Besides,  there  is  also  the  question  of  responsibility.  The 
fact  of  disease  of  the  sexual  instinct  does  not  in  itself  render  the 

1  Binswanger  very  justly  expresses  his  mistrust  of  such  "  auto-suggestions  of  doubt- 
ful value  "  ;  for,  In  his  opinion,  they  might  arise  especially  in  connection  with  the  "  amal- 
gamation of  abnormal  sexual  inclinations  with  increased  physiological  excitability." 
Nowhere,  according  to  Binswanger,  is  there  a  greater  effort  to  be  excused  morally  and 
legally,  and  to  cover  with  the  mantle  of  abnormal  constitution  acts,  which  are  not  in 
accord  with  modern  morality,  than  in  this  domain. 


DIAGNOSIS   AND   PROGNOSIS.  195 

individual  affected  irresponsible.  Only  the  proof  that  the  indi- 
vidual has  committed  a  criminal  act  as  a  result  of  organic  neces- 
sity, as  if  forced  to  it,  and,  owing  to  his  cerebral  constitution, 
was  incapable  to  developing  (or  acquiring)  the  necessary  in- 
hibitory (or  restraining)  ideas,  will  allow  him  to  be  held  as 
devoid  of  free  will.  Very  many  individuals  of  contrary  sexuality 
are  well  able  to  control  their  impulses.  The  broad  leniency 
which  Moll  accords  such  patients,  in  this  respect,  seems  to  me  to 
be  unjustified  ;  and  it  could  be  misused  as  permission  for  the 
justification  of  the  most  vicious  practices. 

Further  diagnostic  details  are  given  in  the  works  of  von 
Krafft-Ebing  and  Moll,  and  in  the  preceding  chapter. 

Dependence  of  Prognosis  upon  the  Causes  of  Origin. — 
The  development  of  the  perversion  depends  upon  the  lack  of  a 
rational  development  of  the  mind  and  will.  The  abnormal 
congenital  disposition  to  perverse  activity  of  the  instinct,  since 
it  must  be  regarded  as  dependent  upon  cerebral  organization, 
can  scarcely  be  removed  by  any  remedial  measure.  Still,  in 
this,  the  severest  form  of  predisposition,  properly-directed 
measures  may  be  successful  in  hindering  the  perverse  tendency; 
in  preventing  the  premature  awakening  of  the  sexual  instinct ; 
and  eventually  in  establishing  normal  sexual  intercourse  by 
artificial  cultivation.  In  isolated  affection  of  the  sexual  instinct 
the  prospects  of  cure  are  better  than  in  individuals  of  defective 
constitution  (Binswanger). 

If  the  form  of  the  perversion  is  not  predetermined  by  the 
organization,  but  developed  by  exciting  causes  on  a  neuropathic 
basis,  a  favorable  prognosis  may  be  given.  For  the  result  of 
education  may,  in  its  turn,  be  overcome  by  education.  The 
general  condition  of  the  nervous  system  will  determine  whether 
merely  improvement  of  a  deeply-rooted  malady  or  complete  cure 
is  possible. 

According  to  von  Krafft-Ebing,  the  occurrence  of  effemi- 
nation  in  individuals  of  contrary  sexuality  is  the  limit  beyond 
which  there  is  no  hope  in  therapeutics.  The  more  closely  the 
abnormal  inclinations  are  united  with  the  constitutional  pecu- 
liarity of  the  individual,  the  slighter  the  prospect  of  lasting 


196  SEXUAL    PAILESTHESIA. 

benefit.  But  this  question  still  seems  to  us  an  open  one ;  in- 
creasing observations  of  the  favorable  results  of  suggestive 
therapeutics  make  it  seem  possible,  perhaps,  to  bring  about  a 
relative  limitation  and  diminution  of  the  acquired  feminine  char- 
acter. Psycho-sexual  hermaphroditism,  cultivated  pederasty, 
and  acquired  contrary  sexual  instinct  in  untainted  individuals 
offer  prospects  of  complete  cure.  Also,  hetero-sexual  rudiments 
in  homo-sexual  individuals  permit  a  hope  of  awakening  normal 
sexual  feelings. 

The  intensity  of  the  impulse  and  the  past  duration  of  the 
condition  must  be  taken  into  consideration  in  the  concrete  case ; 
as  well  as  irritable  weakness  of  the  genito-spinal  centres,  which 
is  a  frequent  accompanying  symptom.  Thus,  even  degenerate 
individuals  may  possibly  be  benefited  to  a  certain  extent. 
Whether,  however,  the  completely-developed  delusion  of  sexual 
transformation,  and  likewise  algolagny  in  its  highest  degree  of 
development  (necrophilia  and  lust-murder),  can  be  influenced, 
seems  questionable.  But  we  are  not  justified  in  stating  that 
there  is  no  hope  while  no  attempts  have  been  made  in  such 
cases  with  hypnosis.  In  a  developed  psychosis,  in  accordance 
with  present  views,  psycho-therapeutics  can  accomplish  little ; 
therefore,  where  sexual  perversion  occurs  as  one  of  the  symp- 
toms of  a  psychosis,  an  unfavorable  prognosis  is  to  be  given, — 
as  in  epileptic  pederasty,  in  the  perversities  of  paretic  dementia, 
and  in  those  occurring  in  certain  states  of  periodical  excitement. 


CHAPTER   XL 

PSYCHICAL  AND  SUGGESTIVE  TREATMENT  OF 
SEXUAL  PERVERSION. 

Consciousness  of  Moral  Duty  as  a  Prophylactic,  with  Re- 
marks on  Education  in  Morals,  from  the  Stand-point  of  the 
Tlieory  of  Suggestion. — The  principal  task  in  the  prophylaxis 
of  sexual  errors  lies  in  education.  A  good  moral  character  is 
the  best  preventive  of  psychoses.  For  passions  and  vices  ex- 
haust the  brain  and  alter  its  constitution.  Through  yielding  to 
dissipation  and  want  of  self-control  many  an  insane  patient  has 
been,  in  part,  responsible  for  his  disease.  The  importance  of 
moral  education  for  mankind  is  shown  by  the  facts  of  heredity. 
Congenital  pathological  changes  of  the  brain,  however,  cannot 
be  influenced  either  by  the  whole  armament  of  moral  treatment 
or  by  other  means.  No  form  of  education  is  capable  of  com- 
pensating for  the  congenital  defect  of  ethical  ideas.  In  such 
a  case,  the  strict  discipline  of  a  well-conducted  institution  is 
indicated. 

Apparent  cures  of  psychical  degeneracy,  as  they  are  occa- 
sionally reported,  in  case  of  correctness  of  diagnosis,  are  ex- 
plicable as  marked  remissions  such  as  occur  in  moral  insanity. 
For,  according  to  the  agreement  of  all  alienists,  original 
psychical  degeneracy  is  incurable. 

As  a  rule,  however,  we  have  to  do  merely  with  predis- 
position to  perverse  actions,  and  here  correct  education  and 
control  of  the  impulse  may  bring  about  improvement.  Con- 
cerning the  .degree  to  which  temperament  and  character  can  be 
influenced  by  pedagogic  means,  there  are  various  opinions. 
That  instincts  can  be  overcome  there  is  no  doubt.1  Taking  the 
idea  of  suggestion  in  its  widest  sense,  all  education  may  be  re- 
garded as  a  combination  of  co-ordinated  and  well-considered 
"  suggestions."  It  does  riot,  of  course,  consist  of  merely  the 

1  Comp.  Guyau,  Education  et  Her£dit6,  Paris,  1890.  This  book  gives  excellent  re- 
marks on  this  subject,  but  it  seems  to  us  to  contain  some  errors  concerning  the  concep- 
tion and  significance  of  suggestion. 

(197) 


198  SEXUAL    PAR^ESTHESIA. 

teachings  of  parents  and  teachers ;  morality,  religious  faith,  and 
related  conversation  and  social  intercourse  have  an  effect  on  the 
brain  that  is  to  a  certain  extent  latent,  and  thus  direct  our  habits. 
But  education  cannot  create  genius,  though  it  may  develop  it. 

Moral  health  is  more  important  than  intellectual  qualities 
for  the  progress  of  the  individual  and  the  race.  Vicious  moral 
instinct  leads  to  deterioration  and  extinction.  Therefore,  the 
creation  of  moral  duties  may  be  regarded  as  the  necessary 
object  of  individual  development.  The  Darwinian  selection  of 
the  useful,  in  social  life  of  animals,  for  example,  also  leads  to 
the  development  or  predominance,  even  though  in  a  broader 
sense,  of  minor  capability  or  peculiarity,  by  sexual  selection. 

Our  acts  are  directed  by  what  we  call  "  duty  " ;  this  is 
the  result  of  morals  and  reflection, — the  product  of  harmony 
brought  about  between  our  dominant  inclinations  and  the 
formulae  that  have  been  suggested  to  us  by  the  influences  of 
education.  With  children,  it  is  sufficient  to  emphasize  this  or 
that  good  peculiarity  that  is  found  in  them  in  order  to  induce 
them  to  develop  this  faith.  Every  lively  image  (idea)  in  con- 
sciousness strives  to  make  itself  real  in  acts.  It  is  necessary  to 
make  the  child  believe  that  it  is  morally  free  and  master  of 
itself.  The  opposite  of  this  is  moral  abulia,  an  active  yielding 
to  the  first  strong  impulse.  To  give  a  child  bad  feelings,  to 
blame  it  unjustly  (compare  Case  67),  is  to  bring  about  the 
opposite  result, — to  point  out  evil  and  develop  it.  Often  the 
child  is  not  conscious  of  doing  wrong.  In  such  cases  it  is 
necessary  to  convince  the  child  that  it  did  not  choose  to  act  so, 
but  did  it  in  mistake.  Just  as  with  hypnotized  subjects,  it  is 
necessary  to  presume  the  existence  of  the  peculiarities  we  wish 
the  pupil  to  possess.  Among  the  most  powerful  means  of  sug- 
gestion are  public  respect  and  self-respect,  since  daily  experience 
shows  that  this  means  alone  is  effective  in  improving  individ- 
uals. The  abandonment  of  evil  ways,  perhaps,  at  first  through 
external  influence,  at  last  becomes  a  habit,  and  the  simultaneous 
direction  of  the  attention  to  good  contributes  its  share  to  the 
modification  of  conviction.  And  in  the  same  manner  an  inner 
transformation  may  likewise  take  place. 


PSYCHICAL   AND    SUGGESTIVE    TREATMENT.  199 

Suggestion  is  merely  the  introduction  of  a  corresponding 
belief  to  be  later  realized ;  the  effect  of  suggestion,  therefore,  con- 
sists of  the  art  of  convincing  an  individual  that  things  are  or  may 
be  different  from  what  they  actually  are.  Thus,  it  is  necessary 
to  convince  children  that  they  are  only  capable  of  good,  and 
absolutely  incapable  of  evil.  The  suggestions  of  early  years  are 
the  most  powerful  of  all.  There  are  good  and  bad  instincts  in 
every  human  being ;  and  it  is  only  necessary  to  guard  the  child 
on  occasion  from  receiving  the  formula  for  the  evil  instincts. 
The  consciousness  of  evil  inclinations,  of  perverse  tendencies  in 
the  vita  sexualis,  as  a  rule,  intensifies  them.  Therefore,  urn- 
ings  try  to  excuse  and  justify  their  passion,  as  we  have  seen,  by 
the  aid  of  the  theory  of  uranism  originating  with  Ulrichs.  The 
educator  must  also  awaken  the  conviction  that  the  individual  is 
capable  of  understanding  his  acts.  To  cause  any  one  to  believe 
that  he  is  a  fool  and  incapable  of  this  or  that  act  is  to  system- 
atically cultivate  foolishness.  Self-confidence  must  be  increased 
by  assurance.  Through  independent  solution  of  difficulties  the 
child  becomes  accustomed  to  being  able  to  do  what  it  wills ;  to 
school  its  will.  Unfortunately,  self-confidence  is  wanting  in 
many  men,  especially  in  neuropaths,  as  is  shown  daily  in  medical 
observation.  Mistrust  of  one's  self  finally  becomes  complete 
inner  powerlessness.  The  conviction  that  one  is  perverse  as  a 
result  of  original  cerebral  constitution  undermines  all  resistance 
to  sensual  impulses.  Indeed,  too  intense  a  feeling  of  deficiency 
may  lead  to  complete  moral  paralysis  and  suicide. 

Thus,  the  great  object  of  education  is  to  create  a  series  of 
habits  by  means  of  direct  persuasion,  acts,  imitation,  and 
admiration.  Parents  and  teachers  have  an  intense  effect  upon 
children  through  example ;  for  children  always  imitate  the  per- 
sons about  them.  And  these  should  always  stand  on  a  moral 
plane  above  that  of  the  child.  A  firm  will,  leaning  to  justice 
and  goodness,  impresses  children ;  that  which  astonishes  most 
the  child  imitates.  Thus,  merely  the  example  of  goodness  may 
actually  improve  an  individual.  It  is  not  mechanical  obedience, 
as  enforced  by  the  disciplinarian,  but  conviction  and  introduc- 
tion by  means  oP  authority  that  are  the  correct  factors  in  educa- 


200  SEXUAL    PAR^STHESIA. 

tion.  When  education  has  been  successful  in  creating  good 
habits,  it  remains  to  awaken  the  belief  that  these  habits  are 
valuable. 

Every  occupation,  every  social  condition,  has  an  educational 
influence.  It  forces  us  to  act  in  conformity  with  a  general  idea. 
Our  conduct  is  always  accommodated  to  social  relations.  By 
this  means,  also,  our  hereditary  tendencies  undergo  modifica- 
tion. Regular  occupation  in  a  calling  has  a  general  moral 
effect.  Want  of  occupation,  on  the  contrary,  removes  the 
individual  from  the  influence  of  many  social  deterrents  and 
abandons  him  to  his  inclinations  and  hereditary  tendencies. 
Therefore,  in  the  education  of  a  child,  the  idea  of  sociability 
should  be  inculcated  as  strongly  as  possible  from  youth  up. 
The  ideal  of  humanity  must  be  to  direct  hereditary  instincts. 
In-  the  sense  here  described  moral  and  social  suggestions  may 
prevent  the  formation  of  a  fixed  idea,  no  matter  whether  it  be 
related  to  crime  or  perversion.  Natures  that  have  lost  equilib- 
rium frequently  are  wanting  in  altruistic  feeling  (e.g.,  the  com- 
plete absence  of  compassion  in  criminals).  And  if  such  a 
feeling  were  present,  in  only  a  rudimentary  form,  in  such  an 
unfortunate  being,  still  education  could  develop  it  and  thus 
restore  equilibrium. 

Well-organized  and  regulated  suggestions  are  capable  of 
repressing  or  favoring  the  effects  of  heredity,  no  matter  whether 
they  be  imparted  during  artificial  sleep  or  in  the  waking  state. 
For  nothing  takes  place  in  hypnosis  that  could  not  be  done  in 
the  waking  state,  more  or  less  perfectly,  even  though  in  a  rudi- 
mentary manner.  Suggestion,  therefore,  does  not  present  any 
isolated  and  remarkable  phenomena.  We  are  all  sensitive  to 
suggestions ;  and  social  life  may  be  regarded  as  a  state  of  equi- 
librium maintained  by  opposing  suggestions.  The  possibility 
of  personal  resistance  to  suggestion  varies  considerably  in  accord- 
ance with  individual  peculiarities.  The  suggestive  impulse  may 
be  looked  upon  as  an  imperative  feeling  instatu  nascendi,  which 
to  a  certain  extent,  like  a  rebel  battles  with  pre-existing  intense 
inclinations,  and  seeks,  at  the  moment  of  suggestion,  to  turn  the 
whole  mind  in  the  direction  of  a  fixed  idea  which  more  and 


PSYCHICAL   AND   SUGGESTIVE   TREATMENT.  201 

more  impresses  the  brain.  At  first  suggestion  always  induces  a 
temporary  emotion,  which,  by  cumulative  effect, — as  in  frequent 
hypnotic  sittings, — becomes  a  habit  in  the  individual.  The 
effect  of  suggestions  during  our  childhood  extends  throughout 
our  lives.  Thus  suggestion  is  a  means  through  which  a  passive 
organism  seeks  to  equalize  itself  with  an  active  organism.  The 
state  of  credulity  in  a  child  is  comparable  with  the  lack  of  re- 
sistive power  in  the  hypnotized  individual.  At  any  rate,  every- 
body believes  most  thoroughly  .what  he  convinces  himself  of; 
and  therefore  auto-suggestions  often  offer  the  most  effectual  re- 
sistance to  therapeutic  suggestions.  The  ability  to  suggest 
finally  becomes  ability  to  assure.  The  deep  tone  of  conviction 
has  the  greatest  suggestive  power.  Those  persons  that  seem  to 
assure  the  most  by  gestures  and  emphasis  are  the  best  hypnotic 
operators.  An  energetic  will  operates  upon  weaker  natures  like 
a  command,  and  awakens  corresponding  feelings.  Without  the 
expectation  of  a  definite  result,  without  faith  in  one's  self,  there 
can  be  no  activity.  Consciousness  of  action  is,  at  bottom, 
nothing  more  than  the  belief  that  one  acts.  Even  a  doubt  may 
disturb  habitual  reflex  acts.  Thus,  conscious  life  depends,  in 
part,  upon  a  relation  in  which  we  stand  with  ourselves. 

Virtue  and  moral  consciousness  are  not  inherited ;  we  in- 
herit only  the  disposition  to  goodness  and  right-willing,  as  we 
may  that  to  cruelty ;  education  is  more  powerful  in  morals  than 
in  intellect.  Every  man,  during  the  course  of  his  life,  comes  to 
formulate  rules  for  his  own  conduct,  which  vary  in  accordance 
with  tastes,  preferences,  habits,  and  needs.  The  criminal,  like 
the  philanthropist,  is  directed  by  constant  rules  which,  at  bottom, 
represent  the  theoretical  formula  of  his  conduct.  In  harmony 
with  the  manner  in  which  the  nucleus  of  the  soul  is  stimulated 
in  the  child,  moral  consciousness  is  developed.  Since  practice 
precedes  theory,  it  is  an  important  principle  in  education  to 
direct  the  acts  of  children  in  a  moral  sense,  before  fundamental 
principles  are  impressed  upon  them.  It  is  best  if,  as  Herbert 
proposes,  children  formulate  rules  for  themselves  from  their  own 
experience. 

True  morality  can  never  be  the  product  of  heredity.     It 


202  SEXUAL    PARyESTHESIA. 

only  results  from  education,  when  our  reason  gains  possession 
of  us.  Therefore,  consciousness  of  a  moral  duty  signifies  con- 
sciousness of  inner  and  well-considered  knowledge  which  directs 
our  acts,  the  presence  of  ideas  which  strive  to  become  real  by 
virtue  of  their  own  power,  and  the  presence  of  feelings  which, 
as  a  result  of  their  development,  have  in  view  the  well-being  of 
fellow-beings. 

Other  Means  for  the  Prevention  of  Sexual  Errors. — If  the 
principles  of  education  here  laid  down  and  studied  with  reference 
to  the  theory  of  suggestion  are  important  in  general  for  the  de- 
velopment of  the  character  in  the  child,  it  is  still  much  more  so 
for  neuropathic  individuals,  in  whom  the  vita  sexualis  seems  to 
be  the  locus  minor  is  resistentice,  and  which,  under  the  influence 
of  unfavorable  conditions,  is  directed  into  perverse  lines.  Sexual 
education,  then,  besides  observance  of  the  measures  given  in 
Section  I,  with  careful  watching  must  endeavor  to  delay  as  long 
as  possible  the  appearance  of  sexual  instinct,  and  to  diminish  its 
intensity  as  much,  as  possible.  Pathogenetic  stimuli,  as  offered  in 
seduction  and  example,  are  to  be  prevented.  In  order  to  pre- 
vent pathological  determination,  care  must  be  taken  that  the 
boy  is  accustomed  to  the  society  of  female  companions.  Notice- 
ably close  friendship  with  boys  and  indifference  toward  girls 
require  the  most  careful  watching  by  parents  and  teacher,  and 
should  arouse  suspicion. 

Especially  in  abnormal  individuals,  the  will  must  be 
schooled  to  control  sensual  impulses.  But  the  inculcation  of 
moral  principles,  great  as  their  worth  may  be,  must  not  go  to 
the  extent  of  the  ascetic  development  of  abstinence  physiologi- 
cally unattainable.  In  one  of  my  cases  the  opposite — love  of 
men — was  artificially  induced.  It  has  been  previously  men- 
tioned that,  at  the  time  of  puberty,  a  rational  explanation  of 
the  sexual  relations  is  a  powerful  prophylactic.  Unfortunately, 
in  most  families,  this  point  is  overlooked.  With  a  negligence 
for  which  there  can  be  no  excuse,  the  determination  of  this 
instinct,  so  important  for  procreation,  is  left  to  accident;  hence 
the  intractable  undifferentiated  sexual  feeling,  excessive  onan- 
ism,  and  the  cultivation  of  perversions.  Ask  such  unfortunate 


PSYCHICAL    AND    SUGGESTIVE   TREATMENT.  203 

persons  who  has  explained  their  malady  to  them,  and  it  will 
be  found  that  it  is  seldom  parent  or  teacher,  but  popular  books, 
friends,  etc.  I  believe  that,  in  severe  forms  of  sexual  perver- 
sion, help  and  cure  are  possible  as  long  as  the  individual  is  still 
undergoing  development.  The  earlier  the  individual  treading 
a  false  path  is  treated,  the  better  the  prognosis.  Where  there 
is  a  certain  amount  of  ethical  weakness,  or  inability  to  form 
inhibitory  ideas,  an  attempt  should  be  made  to  associate  such 
individuals  with  normal  comrades  possessed  of  strong  wills,  to 
whom  passive  natures  easily  accommodate  themselves.  Tar- 
nowsky  thinks  that  slight  ridicule  of  boys  that  manifest  a  pref- 
erence for  female  occupations  may  prevent  the  development  of 
perversion.  At  least,  it  should  be  remembered  that  the  activity 
of  feminine  inclinations  cannot  occur  without  some  fault  in  edu- 
cation. In  all  these  questions,  as  von  Krafft-Ebing  remarks, 
the  family  physician  can  give  assistance  and  exercise  prevention, 
provided  his  advice  is  sought. 

Should  Urnings  be  Treated  ? — A  question  of  prophylaxis 
from  the  stand-point  of  coming  generations  involves  the  pro 
and  con  of  the  treatment  of  urn  ings.  Moll1  raises  the  question 
whether  contrary  sexual  instinct  should  be  treated  medically ; 
indeed,  does  not  pederasty,  according  to  Schopenhauer's  view, 
serve  nature's  purpose,  in  that,  as  a  vice,  it  prevents  the  beget- 
ting of  unfortunate  descendants  by  "  old  and  sexually-depraved 
men  "\  Moll  thinks  that  it  would  be  possible  to  bring  about 
disharmony  in  the  pronounced  effemination  of  an  urning! 

The  writer  mentioned  does  not  feel  justified  in  giving  a 
positive  answer  to  this  question,  but  leaves  it  for  social  and 
legal  determination.. 

Marriage. — I  hold  that,  under  all  circumstances,  medical 
treatment  of  such  unfortunates  is  indicated  as  long  as  it  is  not 
attempted  to  carry  it  beyond  impossible  limits.  That  coming 
generations  must  suffer  as  a  result  is,  as  our  study  of  the  matter 
has  shown,  quite  possible,  but  it  is  by  no  means  proven.  Be- 
sides, the  union  with  a  female  character  may  compensate  the 
peculiarity.  Such  individuals  should  be  directed  to  marry  emo- 

1  Loc.  cit.,  p.  209 


204  SEXUAL    PAR^STHESIA. 

tional  women  possessed  of  lively  sexual  desires.  The  opposing 
characteristics  of  the  mother,  in  accordance  with  the  law  of 
inheritance,  compensate  the  defect  in  the  father,  and  thus  the 
descendant  more  nearly  approaches  the  normal  standard. 

Still,  one  must  be  aware  that  marriage  is  not  a  cure,  for 
psycho-sexual  hermaphrodites  are  not  so  infrequent  among  the 
married.  Tarnowsky  saw  cases  in  which  youths  with  "  con- 
genital sexual  perversion,"  aged  from  25  to  30  years,  became 
capable  of  intercourse  with  women,  married,  and  begat  children. 
Moll  doubts  that  these  persons  became  normal.  I  think  Tar- 
nowsky is  right;  only  they  were  not  cases  of  original  disposition, 
but  perversions  in  predisposed  individuals,  induced  by  exciting 
causes. 

Onanism  and  Exciting  Causes. — Owing  to  the  extremely 
injurious  effect  of  onanism,  which  plays  a  part  in  almost  all 
forms  of  sexual  perversion,  youths  must  be  most  carefully 
watched  on  this 'point,  in  accordance  with  the  advice  given  in 
Section  I  (schools  and  academies).  But  the-  dream-life  and 
pollutions  at  night  must  not  escape  attention.  For  in  case  of 
some  pathological  association  with  abstinence  from  onanistic 
acts,  a  dream-picture  of  perverse  content  with  simultaneous 
pollutions,  as  a  result  of  continued  repetition,  may  assume  the 
role  of  ideas  accompanying  masturbation.  The  abnormality  of 
these  ideas  is  the  starting-point  of  psycho-sexual  disease.  They 
must,  therefore,  not  be  allowed  to  become  the  imperative  product 
of  habit. 

Prophylaxis  against  the  injurious  influences  described  in 
Chapter  IX  is  to  be  carried  out  in  accordance  with  the  pecu- 
liarities of  each  case,  without  any  thought  to  make  a  general 
application  of  the  measures  here  described.  Thus,  for  example, 
in  the  case  of  a  predisposed  boy,  spanking  should  not  be  prac- 
ticed, if  it  induce  sexual  excitement,  in  order  to  nip  algolagnistic 
inclinations  in  the  bud. 

The  therapeutics  of  the  anomalies  of  the  sexual  instinct, 
according  to  von  Krafft-Ebing,  may  be  advantageously  divided 
into  three  parts  : — 

1.  Treatment  of  the   constitutional   disease   forming   the 


PSYCHICAL   AND    SUGGESTIVE    TREATMENT.  205 

basis  of  the  sexual  perversion  (neurasthenia  sexualis  or  univer- 
salis). 

2.  Removal  of  onanism  and  other  influences  injurious  to 
the  vita  sexualis. 

3.  Specific  treatment  of  the  abnormal  instinct. 

Antineurasthenic  treatment,  the  means  of  which  are  suf- 
ficiently well  known,  under  certain  circumstances,  is  alone 
sufficient  to  cure  cases  that  have  made  but  slight  progress. 
Besides  hydro-therapeutic,  electrical,  and  medicinal  means,  severe 
mountain-walks,  extending  over  months,  are  especially  to  be 
commended.  In  addition  to  strengthening  the  constitution, 
they  also  strengthen  the  will. 

The  treatment  of  onanism  is  given  in  detail  in  Section  I, 
and  therefore  we  may  omit  it  here,  as  well  as  that  of  sexual 
hyperaesthesia  and  impotence, — the  most  frequent  accompanying 
symptoms  of  sexual  paraesthesia. 

In  respect  to  the  two  points  mentioned,  almost  all  sexual 
perversions  seem  to  us  amenable  to  medical  treatment ;  perhaps 
cases  of  advanced  dementia  are  exceptions,  as  they  are  rather 
to  be  met  with  in  asylums  than  in  private  practice. 

Psycho-therapeutics  in  Cases  of  Perverse  Instinct. — The 
treatment  of  an  abnormal  instinct  can  be  only  psychical.  Where 
psychical  treatment  in  the  waking  state  is  not  successful,  sug- 
gestion in  hypnosis  may  be  advantageously  brought  into  requi- 
sition. In  all  cases  the  patient  should  be  made  to  school  his 
will,  that  he  may  thus  be  able  to  control  his  impulses.  The 
patient  should  be  advised,  by  energetically  conquering  himself, 
to  think  of  woman  and  the  sexual  act,  and  in  any  sexual  excite- 
ment attempt  to  substitute  woman  for  man.  Many  patients  are 
finally  able,  in  the  struggle  with  themselves,  to  experience 
pleasant  feelings  and  erection  in  the  thought  of  hetero-sexual 
relations.  When  this  is  attained  the  victory  over  the  abnormal 
instinct  is  practically  won. 

In  the  process  of  recovery,  every  person  of  contrary  sexu- 
ality passes  through  the  stage  of  psycho-sexual  hermaphroditism, 
— ra  condition  in  which  he  is  excited  by  both  sexes.  What  at 
first  gives  rise  to  the  greatest  repugnance  (feeling  of  disgust)  by 


206  SEXUAL    PAR^ESTHESIA. 

patient  repetition  finally  becomes  habitual;  and  many  patients 
give  the  assurance  that,  in  sexual  excitement,  they  are  able,  with- 
out the  slightest  difficulty,  to  substitute  female  for  male  fancies. 
Some  of  the  cases  reported  in  the  following  series  clearly  illus- 
trate psycho-therapy  without  hypnosis. 

In  the  treatment  of  urnings,  Moll  correctly  distinguishes 
two  objects :  (a)  overcoming  the  instinct  itself;  (6)  repression 
of  its  activity. 

Of  course,  the  first — that  is,  the  removal  of  perverse  feel- 
ing— is  the  more  important.  I  agree  with  Moll's  view  that,  on 
the  whole,  it  is  advantageous  first  to  suggest  hetero-sexual  feel- 
ings until  the  patient  himself  feels  the  need  to  attempt  coitus. 
That  is  the  natural  manner  of  cure.  The  performance  of  coitus, 
even  when,  in  spite  of  repugnance  and  with  the  help  of  the  per- 
verse imagination,  it  is  successful,  is  in  reality  no  cure.  Want 
of  success,  on  the  other  hand,  causes  a  feeling  of  depression 
and  makes  further  treatment  more  difficult.  From  this  is  de- 
rived, as  a  fundamental  principle  of  treatment,  the  combating 
of  hetero-sexual  feelings  and  the  creation  and  promotion  of 
hetero-sexual  feelings ;  and,  in  the  second  place,  the  direction 
of  the  activity  of  the  instinct  in  a  normal  way.  Further,  it 
should  be  remembered  that  in  neurasthenics  with  perverse  in- 
stincts weakness  of  sexual  power  is  frequent,  and  that  several 
months  of  abstinence  essentially  contribute  to  the  restoration  of 
the  weakened  sexual  function. 

Regulated  Sexual  Intercourse. — With  complete  acknowl- 
edgment of  Moll's  caution  mentioned,  regulated  sexual  inter- 
course seems  to  us  to  be  advantageous  where  the  instinct  and 
effemination,  or  other  perversion,  are  complete.  It  is  very  dif- 
ficult, sometimes  impossible,  for  example,  in  persons  of  fully- 
developed  effemination,  to  induce  by  suggestion  alone  hetero- 
sexual feelings  and  ideas  of  such  intensity  that  erections  occur 
where  the  corresponding  sensory  perceptions  are  wanting  to 
the  patient.  Cases  in  my  experience,  on  the  other  hand,  show 
me  that  patients  who,  in  the  first  attempt  at  coitus,  had  feelings 
of  disgust  and  were  impotent,  in  the  second,  made  on  my  advice, 
under  the  influence  of  alcohol,  were  successful ;  and.  in  the  third 


PSYCHICAL   AND   SUGGESTIVE    TREATMENT.  207 

attempt  proved  potent,  even  though  erection,  was  brought  about 
only  after  manipulation  by  the  puella.  Thus  the  ice  was  broken, 
and  the  patient's  sexual  impulses  were  made  harmless  in  spite 
of  himself.  Sexual  intercourse,  begun  under  such  difficulties, 
must  be  regularly  continued  by  the  patient  until  it  becomes  a 
habit. 

In  patients  that  are  not  weakened  sexually,  finally  spon- 
taneous erections  occur,  and  the  psychical  equivalent — that  is, 
the  psycho-sexual  reflex  effect — must  occur.  Whether  this  com- 
pletely compensates  the  perverse  tendency  depends  upon  the 
degree  of  the  malady  and  individual  conditions.  A  diminution 
of  the  abnormal  ideas  takes  place,  however,  in  all  cases.  Thus, 
Binet  also  observed,  in  fetichists,  that  from  the  moment  of  regu- 
lated sexual  intercourse  the  image  of  the  fetich  paled  and  lost 
its  harmful  influence.  For  abstinence  from  natural  sexual 
congress  induces  sexual  hypereesthesia  and  intensifies  the  im- 
pulse in  its  perverse  direction.  Conversely,  inclination  for 
women  may  arise  from  regulated  coitus.  Indeed,  I  have  ob- 
served that  the  patients  were  able  to  resist  homo-sexual  temp- 
tation as  long  as  intercourse  with  women  was  continued ;  but 
as  soon  as  a  long  pause  occurred,  the  impulse,  fante  de  mieux, 
took  its  old  direction. 

The  relapses  noted  in  my  patients  occurred  at  a  time  when 
they  were  abstaining  (illness,  absence  of  the  physician,  long  ab- 
sence of  the  wife,  etc.).  In  few  severe  cases  will  it  be  possible 
to  obtain  a  relative  cure  in  this  way.  In  severe  cases, — for 
example,  in  well-developed  effemination, — at  least,  it  will  be 
possible  to  bring  about  a  compensation  of  the  perverse  instinct 
in  sexual  relations.  The  patient  regains  his  inner  equilibrium, 
and  at  last  finds  himself  in  the  desired  situation.  In  occasional 
relapses  he  finds  no  pleasure  in  homo-sexual  relations.  More- 
over, in  many  patients  the  occurrence  of  imperative  sexual 
ideas  of  perverse  content  corresponds  with  their  physical  con- 
dition. Deterioration  of  bodily  health  goes  hand-in-hand  with 
the  recurrence  of  homo-sexual  images.  Not  every  case  of  psy- 
chical impotence  in  sexual  perverts  has  its  cause  in  perversion 
of  the  instinct.  Rather,  there  are  also  neurasthenics  in  whom 


208  SEXUAL    PAR^ESTHESIA. 

virility  alternates  with  impotence  periodically,  as  does  depression 
and  exaltation.  Such  neurasthenic  impotence  may  also  exist  in 
individuals  of  contrary  sexuality  without  the  causative  influ- 
ence of  the  abnormality  of  the  instinct. 

But  the  transformation  of  the  sexual  feeling  is  not  without 
effect  on  the  character.  In  one  case  I  observed  that  there  was 
an  increase  of  self-corifidence  and  energy,  the  want  of  which 
was  previously  characteristic  of  the  patient's  malady ;  these  char- 
acteristics were  influenced  by  duties  of  occupation  which  called 
all  his  manly  powers  into  requisition.  In  one  case  of  complete 
effemination,  likewise,  there  was  an  unmistakable  weakening  of 
feminine  peculiarities.  Powder  and  paint  were  no  longer  used; 
the  pictures  of  urnings  disappeared  from  the  wall ;  the  feminine 
articles  of  toilet  were  given  away ;  and  in  some  situations  the 
patient's  conduct  was  much  more  decided ;  and,  besides,  a  cer- 
tain diminution  of  inner  lack  of  control  was  noticeable.  Still, 
as  before,  there  was  interest  in  men,  though  it  was  not  much 
colored  sexually. 

Tarnowsky  also  confirms  the  great  importance  of  regulated 
sexual  intercourse.  He  says : l  "  With  continuance  of  sexual 
intercourse,  especially  with  the  same  person,  the  sexual  perver- 
sion gradually  weakens;  and,  finally,  the  youth,  who  from  birth 
was  disposed  to  perverse  sexual  activity,  becomes  a  man  with 
normal  sexual  functions,  capable  of  family  life." 

Suggestive  Treatment  in  Hypnosis. — With  most  patients, 
energetic  advice — that  is,  the  psycho-therapeutics  of  the  waking 
state — is  not  sufficient;  and  it  then  only  remains  to  make  use  of 
hypnotic  suggestion.  Von  Kraff-Ebing  regards  it  as  the  only 
"  means  of  salvation  "  in  desperate  cases.  Where  rudiments  of 
hetero-sexual  feeling  are  still  present,  these  must  be  strengthened 
by  suggestion  ;  where  they  are  wanting,  the  hetero-sexual  feel- 
ing must  be  artificially  created.  In  suggestion,  as  the  writer 
mentioned  justly  remarks,  we  have  an  excellent  means  with 
which  to  destroy  the  abnormal  psycho-sexual  existence  and 
create  a  new.  Whether,  however,  as  von  Kraff't-Ebing  thinks, 
a  deepening  of  hypnosis  to  somnambulism  is  necessary  for  this, 

lLoc.  cit.,  p.  18. 


PSYCHICAL   AND    SUGGESTIVE    TREATMENT.  209 

seems  questionable.  The  figures  of  the  table  appended  to  the 
following  chapter  give  some  points  concerning  the  susceptibility 
to  hypnosis  in  cases  of  sexual  paraesthesia. 

Binswanger1  regards  the  "  murky  domain  of  perverse  sexual 
instinct,"  in  spite  of  the  available  results  of  experience,  as  not 
conducive  to  exact  knowledge  of  the  curative  effect  of  hypnotic 
suggestion ;  and  he  doubts  the  complete  transformation  of  sexual 
feelings  and  inclinations  by  means  of  hypnosis,  because  he  gives 
no  credit  to  the  statements  of  such  patients  concerning  such 
changes.  In  this  case  he  should  have  given  some  other  ac- 
ceptable criterion,  with  which  such  changes  could  be  judged 
objectively. 

On  the  whole,  neurasthenics — and  it  is  with  such  indi- 
viduals that  we  are,  for  the  most  part,  concerned — are,  as"  has 
been  mentioned,  difficult  to  hypnotize,  and  often  it  is  necessary 
to  bring  about  hypnosis2  with  the  help  of  narcotics.  But  even 
in  deep  hypnosis  it  is  not  always  easy  to  implant  normal  sexual 
feeling.  Often  the  sexual  abnormality  dominates  the  whole 
personality  when  such  patients  have  at  last  come  to  submit  to 
medical  treatment.  In  his  work  Moll  mentions  a  philologist, 
afflicted  with  contrary  sexual  feeling,  who  violently  resisted  the 
suggestion  to  visit  a  certain  woman  at  a  certain  hour.  Moll 
believes  that  the  fear  of  coming  in  contact  with  a  woman  may 
so  rule  the  Timing,  even  in  deep  hypnosis,  that  he  tries  to  avoid 
any  possibility  of  it.  I  have  seen  similar  fear  of  coitus  in  some 
onanists,  as  in  some  persons  of  contrary  sexuality.  I  have 
always  succeeded,  however,  with  the  exception  of  one  case  of 
uranism  treated  only  a  week,  in  inducing  the  patients  to  attempt 
coitus.  When  hetero-sexual  intercourse  has  once  been  suc- 
cessful, as  has  been  said,  it  may  be  regarded  as  the  turning- 
point  for  improvement,  in  spite  of  the  initial  disgust  during  and 
after  coitus. 

Since  the  histories  given  in  the  following  chapter  offer 
opportunity  for  special  therapeutic  details,  we  may  here  con- 
clude the  general  consideration  of  the  principles  of  treatment. 

1  Loc.  cit. 

1  Comp.  von  Schrenck-Notzing  :  Die  Bedeutung  der  Narcotica  far  den  Hypnotlsmus. 
Abel.  Leipzig,  1891. 


CHAPTER   XII. 

HISTORIES  ILLUSTRATING   SUGGESTIVE  THERAPEUTICS 
IN  PERVERSIONS  OF  THE  SEXUAL  INSTINCT. 

THE  following  thirty-two  cases  show  the  importance  of 
suggestion  in  the  most  frequent  form  of  sexual  paraesthesia. 
Two  cases  (40  and  46)  illustrate  psychical  and  auto-suggestive 
treatment  in  the  waking  state.  Among  the  following  cases, 
those  that  have  been  previously  published  in  other  works  are 
indicated  with  their  sources. 

PSYCHO-SEXUAL  HERMAPHKODITISM. 

Case  39.  Psychical  Hermaphrodite  Treated  in  Six  Sittings  without 
Success  (Prof,  von  Krafft-Ebiny}. — F.,  aged  33  years ;  large ;  stately  ; 
abundant  beard.  Mother  and  sister  nervous.  At  the  age  of  12  years 
he  suffered  with  fits  of  depression.  Attempt  at  suicide  at  13  years  of 
age.  For  seven  years  attracted  to  males,  especially  to  male  servants.  At 
the  age  of  12  years  he  slept  in  a  room  with  a  male  servant.  This  ex- 
cited him  excessively  sexually,  and  he  caressed  the  servant  until  the 
latter  consented  to  mutual  masturbation  (pathological  determination  of 
the  undifferentiated  sexual  feeling  by  the  first  object  at  hand. — Von  Sck.). 
In  spite  of  inclination  toward  the  male  sex,  rudiments  of  hetero-sexual 
impulses.  When  a-small  boy  he  felt  a  desire  to  fondle  little  girls  lust- 
fully. At  the  age  of  17  he  was  in  love  with  a  young  girl  of  beautiful 
form,  but  a  year  later  he  was  incapable  of  coitus  with  a  prostitute.  Five 
years  ago  he  performed  coitus  with  a  girl  who  charmed  him  with  her 
beautiful  form.  Indulgence  in  masturbation  from  his  thirteenth  year. 
Embracing  and  kissing  cultivated  urnings  always  induced  ejaculation. 
Dream-pollutions  due  to  dreaming  of  men.  Abhorrence  of  his  perverse 
sexual  impulse. 

Krafft-Ebing's  advice  to  this  patient  consisted  of:  1.  Avoidance  of 
sexual  excitement.  Resistance  to  contrary  sexual  feelings  and  abandon- 
ment of  onanism.  2.  Strengthening  of  the  neurasthenic  nervous  system 
by  suitable  hydro-therapeutic  and  other  cures.  Attempt  at  hypnotic 
treatment  for  the  purpose  of  imparting  suggestions. 

In  six  sittings  both  physician  and  patient  tried  in  vain  to  induce 
hypnosis,  and  further  attempts  were  abandoned. 

Case  40.  Successful  Auto-suggestive  Opposition  of  Homo-sexual 
Inclinations  by  a  Psychical  Hermaphrodite  (von  Krajft-Ebing). — Father 
apoplectic ;  mother  suffered  with  anaemia  and  melancholia.  The  patient 
(210) 


PSYCHO-SEXUAL   HERMAPHRODITISM.  211 

had  enuresis  nocturna  in  childhood,  and  played  with  his  genitals,  for 
which  his  father  tied  him  in  bed.  No  onanism  until  his  fifteenth  year. 
Only  platonic  inclinations  toward  women.  At  the  age  of  18  sexual 
congress  with  a  woman,  without  special  inclination,  but  quite  frequently. 
After  the  occurrence,  old-looking,  melancholic  conduct.  The  patient 
liked  to  imagine  himself  as  humiliated.  Love  of  young  men.  Opposi- 
tion to  it  at  first.  Then  the  patient  became  a  genuine  urning  and 
was  greatly  depressed.  Taedium  vitae  and  misanthropy.  He  became 
a  socialist  and  carried  on  dramatic  studies.  Shame  kept  him  from 
submitting  to  hypnotic  treatment.  "  Now  I  persuaded  myself  that  I 
was  frightfully  weak  to  have  so  little  confidence  in  myself,  and  I  began 
in  earnest  to  overcome  my  homo-sexual  desires.  At  the  same  time  I 
fought  against  my  nervousness  by  leading  a  proper  life.  I  rowed,  fenced, 
was  much  in  the  open  air,  and  had  the  delight,  finally,  on  awaking,  to 
find  myself  another  man.  When  I  thought  of  the  time  from  my  twenti- 
eth to  my  twenty-sixth  year,  it  seemed  to  me  that  a  strange,  disgusting 
man  had  occupied  my  body  during  that  period.  I  was  astounded  that 
the  handsomest  male  waiter  excited  no  interest  in  me.  I  was  disgusted 
when  I  thought  how  such  men  had  once  impressed  me.  My  self-respect 
increased ;  and  since  my  twentieth  year  my  appearance  has  constantly- 
improved.  Relapses  of  my  homo-sexual  desires  occurred,  but  I  re- 
pressed them  energetically.  I  satisfy  my  libido  in  coitus,  and  I  hope, 
by  continuing  to  lead  a  proper  life,  that  my  pleasure  in  it  will  increase." 

Case  41.  Psychical  Hermaphroditism.  Essential  Improvement  by 
Suggestion  (von  Krafft-Ebing}. — Mr.  von  P.,  aged  25,  single,  Pole,  suf- 
fered with  convulsions  when  a  child.  Weakly,  emotional,  irritable.  No 
serious  diseases.  Awakening  of  the  sexual  instinct  before  his  tenth  year. 
His  earliest  memory  of  lustful  feelings  is  of  those  in  connection  with  a 
male  servant.  Later,  lascivious  dreams  of  men.  At  the  circus,  interest 
in  male  performers.  Contact  with  a  youthful  and  muscular  male  form 
induces  ejaculation.  Not  insensible  to  feminine  charms.  He  regards  man 
as  more  beautiful  than  Woman.  Hetero-sexual  congress  since  his  twen- 
tieth year,  as  a  result  of  excessive  libido.  No  manual,  but  frequently 
psychical,  onanism.  Coitus  successful,  but  devoid  of  pleasure  and  lustful 
feeling.  Enforced  abstinence  from  his  twenty-second  to  his  twenty- 
fourth  year ;  faute  de  mieux,  psychical  onauism.  For  a  year  there  had 
been  defective  libido  for  women,  insufficient  erection,  and  premature 
ejaculation.  Coitus  given  up ;  libido  for  men.  Owing  to  the  irritable 
weakness  of  the  ejaculation-centre,  simply  the  touch  of  an  attractive 
man  induces  ejaculation.  Family  circumstances  force  him  to  marrj' ;  he 
regards  himself  as  psj'chically  impotent,  and  seeks  help. 

The  patient  is  masculine  in  appearance.  Cranium  slightly  hydro- 
cephalic  and  rhombic.  Abundant  beard.  Genitals  normal.  Cremasteric 
reflex  cannot  be  elicited.  No  symptoms  of  neurasthenia.  Neuropathic 


212  SEXUAL    PAR^ESTHESIA. 

eyes.  Pollutions  infrequent.  Erections  occur  only  on  meeting  very 
attractive  men.  July  16, 1889,  first  hypnotic  sitting.  The  third  sitting, 
on  the  18th,  first  induces  deep  lethargy.  Suggestions :  No  inclinations 
for  men ;  love  for  the  female  sex ;  complete  virility.  The  degree  of 
hypnosis  never  goes  beyond  lethargy.  The  suggestions  are  accepted. 
On  the  24th  the  patient  announces  that  he  has  had  coitus  with  enjoy- 
ment. At  the  same  time,  he  still  thinks  man  more  beautiful  than  woman. 
August  1,  1889,  the  treatment  was  necessarily  interrupted.  Result: 
complete  virility;  complete  indifference  for  both  the  male  and  female 
sexes. 

Case  42.  Psycho-sexual  Hermaphroditism  Completely  Cured  by  Sev- 
eral Months  of  Treatment  by  Suggestion.1  Report  of  the  Duration  of  the 
Cure  One  Year  After  Discharge  (von  Krafft-Ebing). — Mr.  von  X.,  aged 
25  ;  landed  proprietor.  He  comes  from  a  neuropathic,  passionate  father ; 
normal  sexually.  Mother  and  two  sisters  nervous.  Maternal  grand- 
mother was  nervous,  and  his  maternal  grandfather  was  a  roue,  much  given 
to  venery.  Patient  is  like  his  mother,  and  an  only  child.  From  birth  he 
was  weak,  suffered  much  with  migraine,  and  was  nervous.  He  passed 
through  several  illnesses.  At  15  he  began  masturbation  without  having 
been  taught  it.  Until  his  seventeenth  year,  he  sa}Ts,  he  never  had  feeling 
for  men  or,  in  fact,  any  sexual  inclination;  but  at  this  time  desire  for 
men  arose.  He  fell  in  love  with  a  comrade  ;  his  friend  returned  his  love. 
They  embraced  and  kissed  and  indulged  in  mutual  onanism.  Occasion- 
ally, patient  practiced  coitus  inter  femora  viri.  He  abhorred  pederasty. 
Lascivious  dreams  were  only  about  men.  In  the  circus  and  theatre 
males  alone  interested  him.  His  inclination  was  for  those  of  about  20 
years  of  age.  Handsome,  tall  forms  were  enticing.  Given  these  con- 
ditions, he  was  quite  indifferent  to  other  characteristics  of  the  man.  In 
his  sexual  affairs  with  men,  his  part  was  always  that  of  a  man. 

After  his  eighteenth  year  the  patient  was  always  a  source  of 
anxiety  to  his  parents ;  for  he  then  began  a  love-affair  with  a  male  waiter, 
who  fleeced  him  and  made  him  an  object  of  remark  and  ridicule.  He 
was  taken  home.  He  consorted  with  servants  and  hostlers.  He  caused  a 
scandal.  He  was  sent  away  for  travel.  In  London  he  got  into  a  "  black- 
mailing scrape,"  but  succeeded  in  escaping  to  his  home. 

He  profited  in  no  way  by  this  bitter  experience,  and  again  showed 
disgraceful  inclinations  for  men.  Patient  was  sent  to  me  to  be  cured  of 
his  fatal  peculiarity  (December  12,  1888).  Patient  is  a  large,  stately, 
robust  young  man,  of  masculine  build  ;  large,  well-formed  genitals.  Gait, 
voice,  and  attitude  are  masculine.  He  has  no  pronounced  mascul'ine  pas- 
sions. He  smokes  but  little,  and  only  cigarettes  ;  drinks  little,  and  is  fond 
of  confectionery.  He  loves  music,  art,  aesthetics,  flowers,  and  moves  in 
ladies'  society  by  preference.  He  wears  a  moustache,  the  face  being  other- 

1  Psychopathia  Sexual  is,  Case  139. 


PSYCHO-SEXUAL   HERMAPHRODITISM.  213 

wise  cleanly  shaved.  His  garments  are  in  nowise  remarkable.  He  is  a 
soft,  blase  fellow,  and  a  do-nothing.  He  lies  abed  mornings,  and  can 
scarcely  be  made  to  rise  before  noon.  He  says  he  has  never  regarded  his 
inclination  toward  his  own  sex  as  abnormal.  He  looks  upon  it  as  con- 
genital ;  but,  taught  by  his  sad  experiences,  he  wishes  to  be  cured  of  his 
perversion.  He  has  little  faith  in  his  own  will.  He  has  tried  to  help  him- 
self, but  always  begins  to  masturbate.  This  he  finds  injurious,  inasmuch 
as  it  causes  slight  neurasthenic  symptoms.  There  is  no  moral  defect ;  in- 
telligence a  little  below  the  average.  Careful  education  and  aristocratic 
manners  are  apparent.  The  exquisite  neuropathic  eye  betrays  the 
nervous  constitution.  He  has  hetero-sexual  feelings,  but  his  sensual  in- 
clinations toward  the  opposite  sex  are  weak  and  infrequent.  At  the  age 
of  19  he  was  first  taken  to  a  brothel  by  his  friends.  No  horror  feminse  ; 
efficient  erections  and  some  pleasure  in  coitus,  but  not  the  instinctive 
delight  he  had  experienced  while  embracing  men. 

Since  then,  the  patient  states,  he  has  had  coitus  six  times,  twice 
sua  sponte.  He  asserts  that  he  is  always  capable  of  it,  but  he  performs 
it  only  faute  de  mieux,  as  he  does  masturbation  when  the  sexual  impulse 
troubles  him,  as  a  substitute  for  congress  with  men.  Rudiments  of 
sexual  feeling  present.  The  indications  were  clear  enough.  Hansen 
had  tried  in  vain  to  hypnotize  the  patient.  To  the  astonishment  of  the 
physician,  Bernheim;s  method  immediately  induced  deep  lethargy,  with 
possibility  of  post-hypnotic  suggestion. 

At  the  second  sitting  somnambulism  by  simply  looking  at  him. 
Suggestive  contractures  possible.-  Awakening  by  counting  three.  Am- 
nesia for"  the  events  of  the  hypnosis.  Repetition  of  the  ti'eatment  every 
second  or  third  day,  together  with  moral  and  hydro-therapeutic  treat- 
ment. Suggestions :  Horror  of  onanism ;  repugnance  for  men ;  inclination 
for  women.  Patient  repeats  the  suggestions  at  each  sitting. 

After  the  fourth  sitting  it  was  noticed  that  the  patient  paid  atten- 
tions to  ladies  in  the  circles  to  which  he  was  introduced.  Soon  after  he 
was  much  taken  with  a  prima-donna.  Some  days  later  he  sought  the 
address  of  a  brothel. 

February  17th.  Asks  to  be  allowed  to  perform  coitus.  Satisfied 
with  his  experience  with  a  member  of  the  demi-monde. 

March  16th.  Hypnotic  treatment  twice  a  week  up  to  this  date. 
Patient  states  that  he  is  free  from  onanism  and  sexual  feelings  for  men. 
Since  he  gives  the  same  answers  in  hypnosis, — e.g.,  that  on  such  and 
such  a  date  he  practiced  onanism  for  the  last  time,  and  that  he  is  too 
much  under  the  will  of  the  physician  to  be  able  to  lie, — his  assertions 
deserve  belief;  the  more,  since  he  looks  well  and  is  free  from  all  neuras- 
thenic symptoms,  and,  in  the  society  of  men,  not  the  slightest  suspicion 
rests  on  him.  An  open,  free,  and  manly  bearing  is  developed. 

Moreover,  since,  of  his  own  will,  he  now  and  then  indulges  in 


214  SEXUAL    PAILESTHESIA. 

coitus  with  pleasure,  and  occasional  pollutions  are  induced  by  lascivious 
dreams  which  concern  women,  there  can  be  no  doubt  of  the  favorable 
change  of  his  vita  sexualis ;  and  it  is  presumable  that  the  hypnotic  sug- 
gestions have  developed  into  auto-suggestive  inclinations,  which  direct 
his  feelings,  thoughts,  and  will.  Probably  the  patient  will  always  remain 
a  natura  frigida  ;  but  he  more  often  speaks  of  marriage,  and  of  his  inten- 
tion to  win  a  wife  as  soon  as  he  has  become  acquainted  with  a  sympathetic 
lady.  Treatment  ceased.  In  July,  1889,  a  letter  from  his  father  told  of 
his  good  health  and  conduct. 

May  24,  1890,  accidental  meeting  on  a  journey.  Patient  had  never 
again  experienced  male-love.  Performed  coitus  occasionally  with  com- 
plete enjoyment.  He  now  thought  seriously  of  marriage.  I  hypnotized 
the  patient,  to  test  him,  in  the  former  manner,  and  asked  for  the  com- 
mands I  had  formerly  given  him.  In  deep  somnambulism,  and  in  the 
same  tone  of  voice  as  formerly,  the  patient  repeated  the  suggestions 
given  him  in  1888, — an  excellent  example  of  the  endurance  and  power  of 
post-hypnotic  suggestion. 

Case  43.  Psychical  Hermaphroditism ;  Improvement  by  Hypnotic 
Treatment.1 — K.,  aged  23;  Russian,  of  prominent  family.  Well  endowed 
mentally  ;  scrofulous  when  a  child.  Father  a  roue.  Father's  brother  is 
said  to  have  been  contrary  sexually.  At  the  age  of  7,  love  of  coachmen 
and  servants  wearing  moustaches.  Close  contact  with  such  persons  gave 
him  a  feeling  of  delight.  In  the  cadet  corps,  taught  mutual  onanism 
and  coitus  inter  femora  viri.  At  17,  first  coitus  with  a  prostitute.  He 
performed  the  act  normally,  but  without  enjoyment.  Frequent  coitus; 
gonorrhoea.  Growing  aversion  to  the  female  sex.  Then  coitus  only 
when  male  intercourse  became  impossible.  Especial  partiality  for  well- 
formed  men  without  beards.  Coitus  buccalis ;  active  and  passive 
pederasty.  Shame  caused  an  attempt  to  reform  by  means  of  coitus  with 
women.  Moral  strength  was  insufficient ;  women  were  repugnant  to  him. 
Never  any  dreams  of  women. 

When  the  patient  came  for  consultation,  he  had  last  had  coitus 
three  weeks  previously,  but  without  pleasure.  He  does  not  regard  his 
case  as  hopeless.  He  gave  up  his  commission  as  an  officer  because 
soldiers  excited  him  so  sexually. 

No  degenerative  signs.  Examination  of  semen  showed  abundant 
spermatozoa.  Penis  large,  well-developed.  Hair  on  genitals  and  beard 
abundant.  No  pleasure  in  drinking  and  smoking  ;  otherwise  of  mascu- 
line tastes.  Neuropathic  eyes.  Usually  takes  the  male  role  in  the  sexual 
act  with  men ;  now  and  then  the  female. 

Attempts  at  hypnosis  induced  lethargy  and  cataleptiform  state  of 
the  muscles.  Condition  used  to  impart  suggestions. 

After  the  fourth  sitting  he  says  he  is  satisfied,  and  he  wonders 
1  Psyehopathia  Sexualis. 


PSYCHO-SEXUAL   HERMAPHRODITISM.  215 

that  men  no  longer  interest  him.  He  wants  to  try  his  luck  with  women, 
but  fears  impotence.  After  the  sixth  sitting  he  voluntarily  tries  coitus 
cum  muliere.  Great  libido  ;  but  in  the  act  this  and  erection  left  him. 
After  the  ninth  sitting  the  patient  discontinued  treatment  on  account  of 
business  at  home.  He  feels  satisfied  in  that  he  is  indifferent  toward 
men  and  capable  of  resistance.  He  thinks  he  is  in  no  danger  of  relapse. 
At  the  time  he  felt  as  little  interest  in  women  as  in  men. 

Case  44.  Psychical  Hermaphroditism  Cured  by  Hypnotic  Sug- 
gestions.1— Z.,  aged  29  years.  Mother  nervous ;  father  and  grandparents 
healthy.  Only  child ;  spoiled.  At  the  age  of  8  his  sexual  libido  was 
intensely  excited  by  a  male  servant,  who  showed  him  pornographic  pict- 
ures and  his  penis.  At  12,  love  of  his  tutor.  When  going  to  sleep  his 
nude  form  appeared  to  him.  He  conceived  himself  in  a  feminine  situation 
with  reference  to  him,  and  reveled  in  the  thought  of  marrying  him  some 
day.  At  13  a  37oung  governess  excited  his  fancy,  and  at  15  he  fell  in 
love  with  a  young  lady.  No  onanism.  Sensually  excitable,  but  only  to 
attractive  men. 

At  20  the  patient  became  neurasthenic  (ex  abstinentia  ?).  He 
attempted  coitus  without  success.  On  the  occasion  of  a  Turkish  bath, 
intense  libido  at  sight  of  a  nude  man.  This  person  approached  him  and 
performed  masturbation  on  him,  which  gave  the  patient  intense  pleasure. 

Until  he  was  25.  masturbation  once  a  month  by  this  man.  During 
this  time  interest  in  a  young  peasant,  who,  however,  would  not  yield  to 
his  desires.  Separated  from  his  lover,  patient  began  auto-masturbation. 

Increase  of  neurasthenia.  Inability  to  work ;  shyness,  dysthj*mic, 
and  abulic.  Unsuccessful  treatment  by  hydro-therapy.  Late  in  February, 
1890,  he  went  to  Prof,  von  Krafft-Ebing.  Decidedly  masculine  in  appear- 
ance ;  neuropathic.  Tall ;  large  ears,  lobules  passing  into  the  skin  of 
the  cheeks.  Genitals  normal.  Cerebro-spinal  neurasthenia  of  moderate 
degree.  Taedium  vitas.  Much  depressed  by  his  sexual  abnormality. 
No  interest  in  women  except  intellectual.  Dreams  were  also  about  per- 
sons of  the  opposite  sex.  The  most  refined  puella  could  not  induce 
erection  in  him.  Passive  or  mutual  onanism  with  men ;  faute  de  mieux, 
auto-masturbation.  Abstinence  during  last  five  months.  No  homo- 
sexual intercourse  since  August,  1889. 

An  attempt  at  hypnosis  by  Bernheim's  method  failed.  Prolonged 
stroking  of  the  brow  produces  deep  lethargy  with  catalepsy.  Somnam- 
bulism impossible.  In  the  third  sitting,  suggestion  that  onanism  and 
male-love  are  repulsive,  and  that  woman  is  beautiful.  Dreams  of  women 
suggested.  Noticeable  change  in  the  mental  attitude  after  the  sixth  sit- 
ting. Patient  quieter,  freer;  dreams  of  women.  Approaches  women, 
but  they  do  not  attract  him. 

He  went  home  March  19th.  Returned  for  treatment  May  17,  1890. 
1  Psycbopathia  Sexualis. 


21 6  SEXUAL    PAILESTHESIA. 

No  masturbation  in  the  interval.  Two  platonic  dreams  of  women;  cere- 
bral asthenia  increased.  He  apparently  suffers  from  want  of  mental 
and  sensual  satisfaction  of  his  vita  sexualis.  Depressed  to  taedium  vitae. 
Hydro-therapeutic,  electrical,  and  antineurasthenic  treatment.  During 
ten  weeks  gradual  disappearance  of  the  troubles  and  change  of  his 
psychical  condition.  The  initiative  in  hetero-sexual  intercourse  is  left  to 
the  patient.  He  now  takes  journeys  in  the  mountains  and  forest ;  his 
boudoir  becomes  a  work-room.  In  the  fourteenth  week  of  treatment,  suc- 
cessful coitus.  The  patient  became  a  happy  man  in  body  and  mind.  He 
expressed  the  best  hope  for  his  future,  and  had  thoughts  of  marriage. 
He  experienced  increasing  pleasure  in  normal  sexual  congress ;  had  las- 
civious dreams  of  women  occasionally,  but  never  of  men. 

Cessation  of  treatment  late  in  September.  He  feels  normal  in 
hetero-sexual  congress,  free  from  neurasthenia,  and  thinks  of  matrimony. 
At  the  same  time,  he  confesses  that  he  still  always  has  erection  at  the 
sight  of  a  nude,  handsome  man ;  but  he  is  able  to  resist  his  desires 
easily,  and  in  his  dream-life  his  relations  are  exclusively  dvec  lafemme, 

As  Prof,  von  Krafft-Ebing  informed  me  by  letter  in  October,  1891, 
in  October,  1890,  before  leaving  Vienna,  the  patient  had  coitus  twice  a 
week  with  pleasure,  and  without  the  assistance  of  the  puella.  As  a 
report  from  the  patient,  April  8,  1891,  stated,  he  had  given  up  masturba- 
tion entirely,  and  made  no  approaches  to  men,  even  though  he  had  not 
entirely  lost  all  inclination  to  do  so.  This  inclination  showed  itself  only 
after  coitus,  but  he  dreamed  only  of  women.  Antineurasthenic  treatment 
recommended  for  nervous  symptoms  that  had  again  appeared  of  late. 

Case  45.  Psychical  Hermaphroditism  Improved  by  Fourteen  Hyp- 
notic Sittings  (von  Krafft-Ebing'). — Male,  aged  33  years ;  born  out  of  wed- 
lock. Father  and  mother  were  cousins.  Father  said  to  have  had  sexual 
disease,  but  not  contrary  sexually.  Mother  eccentric  ;  made  journeys  in 
male  attire  ;  very  decided  character;  smoked,  and  wore  short  hair ;  died 
unmarried.  Appearance  masculine.  In  childhood,  hydrocephalus  and 
slow  mental  development.  Taught  onanism  by  a  room-mate  at  tfhe  age 
of  13  years.  He  practiced  it  passionately.  Ideas  of  men  while  mastur- 
bating and  in  dreams.  Inclination  to  pederasty.  At  19  years  of  age 
coitus  six  times  with  women ;  erection  and  ejaculation  prompt,  but  with- 
out special  feeling  of  pleasure.  Love  of  a  remarkably  beautiful  lady 
at  a  watering-place  made  the  patient  happy  and  kept  him  from  onanism 
temporarily.  After  two  years,  complete  cooling  of  his  feeling  for  women. 
Attempts  at  coitus  do  not  induce  ejaculation.  A  former  school-mate 
attempted  immissio  penis  in  anum  with  the  patient,  which  gave  him 
an  unexpected  feeling  of  pleasure.  Then  mutual  onanism  with  an 
hussar,  and  receptio  penis  ejus  in  os  of  the  patient.  Later,  pederasty 
with  a  sailor.  Love  of  passive  pederasty  more  and  more  developed. 
Lascivious  interest  caused  him  to  peruse  "  Psychopathia  Sexualis." 


CONTRARY   SEXUAL  INSTINCT.  217 

Unexpected  deep  impression.  "The  description  of  cultivating  mujerados 
excited  me  intensely,  so  that  I  masturbated  five  times  in  the  next  two 
days,  thinking  of  myself  as  a  presumptive  mujerado.  The  moral  earnest- 
ness of  the  book  brought  me  to  a  decision  to  seek  help  of  its  author." 
There  was  even  some  result  from  the  reading  of  the  book ;  for  since  then 
the  patient  had  practiced  auto-masturbation  but  twice,  and  mutual  mas- 
turbation with  cavalrymen  but  twice.  Hansen  tried  in  vain  to  hypnotize 
the  patient. 

In  the  spring  of  1891  the  patient  visited  Prof,  von  Krafft-Ebing. 
"  He  experiences  moral  disgust  when  he  performs  the  act  with  a  man,  and 
yet  the  look  of  a  handsome  soldier  actually  electrifies  him.  For  years 
he  has  had  not  the  slightest  sympathy  for  women,  not  even  mentally." 
Patient's  cranium  exquisitely  hydrocephalic  and  plagiocephalic. 

Hypnosis  difficult;  only  with  the  help  of  Braid's  method  and  a  few 
drops  of  chloroform  in  the  third  sitting  was  it  possible  to  induce  deep 
lethargy.  After  that,  merely  looking  at  a  shining  light  was  sufficient. 
The  suggestions  consisted  of  forbiddance  of  masturbation,  removal  of 
homo-sexual  feelings,  and  the  assurance  that  the  patient  would  have 
inclination  for  women,  and  virility  and  pleasure  only  in  hetero-sexual 
congress. 

Masturbation  was  indulged  in  but  once  more.  After  the  eighth 
sitting  the  patient  dreamed  of  a  woman.  When,  after  the  fourteenth 
sitting,  the  patient  was  forced  to  leave,  he  declared  himself  free  from 
inclination  to  onanism  and  male-love,  but  the  desire  for  men  was  by  no 
means  extinguished. 

He  felt  returning  interest  in  the  female  sex,  and  hoped,  by  continu- 
ing treatment,  to  be  finally  freed  from  his  vicious  peculiarity. 

CONTRARY  SEXUAL  INSTINCT. 

Case  46.  Eeported  by  Gharcot  and  Magnan.1  Contrary  Sexual 
Instinct.  Successful  Psychical  Treatment  in  the  Waking  State. — "  My 
sexual  feelings,"  the  patient  states,  "  were  manifested  from  my  sixteenth 
year  in  an  extraordinary  impulse  to  see  boys  of  my  own  age  and  men  in 
a  state  of  nudity.  It  was  not  difficult  for  me  to  gratify  this  inclination, 
for  my  parents  lived  close  to  a  garrison,  and  the  soldiers  took  no  trouble 
to  conceal  their  genitals.  One  day — I  was  then  8  years  old — I  saw  a 
soldier  masturbate.  I  imitated  him  and  experienced,  besides  the  pleas- 
ure of  imitating  a  soldier,  the  pleasant  sensation  of  the  friction.  I  again 
sought  the  same  pleasure  by  exciting  my  fancy  with  the  thought  of  naked 
men.  My  parents  left  N.  and  moved  to  B.  There  I  saw  the  soldiers 
bathe  naked  in  a  small  stream.  I  determined,  in  order  to  have  the  de- 
sired pleasure,  to  seat  myself  on  a  bench  near  the  stream,  pretending  to 
sketch  the  landscape,  while  I  could  thus  see  the  bathers  without  attract- 
ing attention. 

1  Archiv  de  Neurologic,  No.  7,  p.  54. 


218  SEXUAL    PAR^STHESIA. 

"  At  about  15  I  attained  puberty,  and  experienced  much  more  satis- 
faction in  onanism ;  indeed,  I  could  induce  erection  and  its  results  as 
well  by  my  fancy  as  by  friction.  More  than  once  I  bad  erections,  sexual 
excitement,  and  ejaculation  merely  on  looking  at  a  man's  genitals. 
If  my  fancy  became  excited  in  sleep,  the  same  phenomena  occurred.  At 
20  I  gave  up  onanism ;  but  all  my  efforts  were  incapable  of  controlling 
the  excitation  of  my  imagination.  Muscular,  handsome  men  always 
excited  me  intensely  ;  every  beautiful  statue  of  a  nude  man  had  the  same 
effect  on  me.  The  Apollo  Belvidere  excited  me  intensely.  When  I  met 
a  man  who  excited  me  by  his  beauty  and  youth,  I  was  impelled  to  show 
him  every  attention,  and  if  I  did  not  forcibly  control  my  feelings  I  could 
have  done  anything  for  him.  I  should  have  been  delighted  to  invite  him 
to  my  house,  and  to  write  to  him  only  on  perfumed  paper.  I  could  have 
sent  him  flowers  and  made  him  presents,  and  gladly  robbed  myself  of 
many  things  to  show  him  my  favor.  I  have  never  done  all  this,  but  I 
should  only  too  gladly  have  done  it.  I  tried  stoutly  to  control  myself 
and  overcome  the  impulse  I  felt.  I  was  finally  successful  in  banishing 
the  inclinations  mentioned,  though  I  was  never  able  to  repress  the  love  I 
felt.  Fortunately  for  me,  my  love  was  fickle. 

"  Occupation  and  study  have  done  much  to  overpower  my  sensual 
thoughts.  Still  sensuality  often  triumphs  ;  then  1  am  forced  to  stop  work 
because  a  naked  form  rises  in  my  fancy.  I  have  always  fought  against 
this  sensuality  as  much  as  I  could,  and  often  restrained  myself  from  acts 
to  which  I  have  been  impelled,  but  at  no  time  have  I  been  able  to  ex- 
tinguish my  sensuality  entirely.  The  greatest  satisfaction  of  this  feel- 
ing was  experienced  when  I  saw  a  naked  man,  especially  his  penis.  At 
the  same  time,  I  have  never  felt  any  desire  to  approach  a  man  or  to  allow 
one  to  use  me.  The  sight  of  the  genitals  of  a  strong  young  man  has 
always  given  me  the  greatest  lustful  enjoyment. 

"  Women,  on  the  contrary,  no  matter  how  beautiful,  have  never  ex- 
cited the  slightest  desire  in  me.  I  tried  to  love  a  girl,  thinking  thus  to 
direct  my  thoughts  to  a  natural  channel,  but,  though  she  was  very  beau- 
tiful and  reciprocated,  I  remained  entirely  indifferent ;  and  of  erections, 
which  occurred  so  easily  at  the  sight  of  a  man,  there  was  never  a  trace. 
No  woman  has  ever  excited  the  slightest  sexual  feeling  in  me.  I  admire 
their  toilettes  and  like  to  see  a  beautifully-dressed  woman ;  for  I  think 
that  if  I  were  a  woman  I  would  dress  so.  At  the  age  of  17,  at  a  carnival, 
I  wore  female  garments,  and  had  a  feeling  of  indescribable  pleasure  when 
I  felt  my  skirts  slipping  along  the  floor  behind  me;  also  when  I  dressed 
my  false  hair  and  put  on  my  decollete  dress.  Until  my  twenty-second 
year  it  gave  me  much  delight  to  dress  dolls,  and  this  even  still  affords  me 
pleasure.  Ladies  are  often  astonished  to  hear  my  excellent  judgment  of 
appropriate  and  inappropriate  toilettes,  as  well  as  concerning  other 
things  which  belong  entirely  to  woman's  sphere.  The  love  I  may  feel 


CONTRARY   SEXUAL   INSTINCT.  219 

for  any  one  woman  soon  passes ;  for  the  next  one  more  beautiful  erases 
the  memory  of  the  preceding.  In  the  last  few  months  pollutions  at  night 
have  not  been  so  frequent  as  formerly.  I  have  had  none  in  the  last  three 
weeks,  but  I  still  have  my  customary  dreams  and  my  longing  to  see 
nude  men.'' 

Charcot  and  Magnan  advised  the  patient  when  excited  to 
substitute  a  woman  for  a  man  in  his  fancy.  He  tried  strenu- 
ously to  do  this,  but  for  the  most  part  in  vain.  After  a  struggle 
of  several  months'  duration  he  finally  had  a  little  success,  and 
went  so  far  as  to  be  able  to  have  sexual  congress  with  a  woman, 
which  gave  him  pleasant  sensations.  The  psychical  effect  was 
excellent,  and  in  a  few  days  he  was  free  from  his  former  feelings. 
When,  however,  he  was  compelled  to  leave  Paris  for  a  time, 
and  was  thus  forced  to  combat  his  old  impulse  with  his  own 
reason  alone,  the  old  inclinations  began  again  to  predominate. 

In  this  case,  besides  psychical  treatment,  hydro-therapy 
(cold  showers  and  douches)  and  bromides  were  used ;  which 
lessened  the  intensity  and  duration  of  the  attacks,  but  did  not 
influence  their  frequency. 

The  foregoing  case  seemed  to  me  worthy  of  report  for 
various  reasons.  It  shows,  first,  how  the  eight-year-old  boy's 
attention  was  excited  by  external  influence  to  male  genitals  and 
onanism.  In  imitating  the  act,  the  person  seen  was  present  in 
the  boy's  mind.  The  pathological  association  was  thus  formed  ; 
it  became  associated  with  lustful  feeling  and  intensified  by  fre- 
quency of  repetition.  And  thus  the  impressionability  of  the 
patient's  imagination,  exercised  one-sidedly,  for  hetero-sexual 
stimuli,  disappeared.  The  reflex  effect  on  his  character  was  not 
wanting ;  he  wore  female  attire  at  the  carnival,  played  with 
dolls,  etc. 

The  pathological  product  of  cultivation,  probably  made 
possible  by  an  hereditary  neuropathic  disposition,  should  then 
be  combated  by  methodical  self-discipline  and  substitution  of 
ideas  of  women  in  contrary  sexual  excitement.  This  succeeds 
to  a  certain  extent ;  the  right  road  to  recovery  is  thus  undoubt- 
edly found;  but  hypnotic  treatment  would  have  lightened  the 
patient's  task.  The  time  of  treatment,  as  far  as  can  be  judged 


220  SEXUAL    PARJESTHESIA. 

from  the  report,  stands  in  no  relation  to  the  time  required  in  the 
development  of  the  malady.  In  the  foregoing  case,  in  my 
opinion,  there  was  possibility  jof  a  complete  cure.  The  fact 
that  the  circumstances  of  the  patient  did  not  allow  systematic 
pursuit  of  the  treatment  does  not  negative  this. 

Case  47.  Reported  by  Dr.  Wetter  sir  and*  Stockholm.  Contrary 
Sexual  Instinct  Cured  in  Seventeen  Hypnotic  Sittings. — X.  X.,  merchant, 
aged  32.  On  the  occasion  of  his  visit,  August  30,  1889,  the  patient  told 
me  that  he  had  been  given  to  onanism  since  his  thirteenth  year,  and  that 
he  began  to  have  intercourse  with  his  own  sex  in  his  twenty-fifth  year. 
He  had  performed  coitus,  which  caused  him  disgust  and  repugnance,  but 
a  few  times,  and  not  at  all  for  many  years.  He  had  a  strongly-developed 
sexual  instinct,  and  found  his  greatest  delight  in  the  embrace  of  men. 
Only  when  he  had  no  opportunity  for  this  did  he  avail  himself  of 
onanism.  His  greatest  desire  is  for  men,  and  he  can  spend  days  seeking 
them. 

To  satisfy  this  lust  he  visits  water-closets,  where  the  sight  of  male 
genitals  gives  him  pleasure.  It  seems  to  him  that  he  has  a  feminine 
nature,  and  not  a  man's  feeling.  He  is  of  powerful  masculine  appear- 
ance ;  genital  hair  and  beard  not  much  developed.  His  voice  is  mascu- 
line, but  his  character  is  somewhat  feminine.  As  far  as  he  knows,  none 
of  his  relatives  suffer  with  a  similar  malady.  He  weeps,  wrings  his 
hands,  and  is  in  despair  at  his  unhappy  fate. 

He  had  previously  tried  hypnotic  treatment ;  but,  perceiving  no 
improvement  after  thirty  sittings,  he  gave  it  up.  Strange  to  say,  I  was 
successful  in  producing  deep  sleep  on  the  first  trial,  with  complete 
amnesia  on  waking.  '  After  seventeen  sittings,  late  in  September,  he  was 
fully  recovered.  I  have  often  seen  him  since,  and  have  never  met  a  more 
grateful  man.  He  calls  me  his  saviour,  and  now  hates  what  formerly  gave 
him  his  greatest  enjoyment. 

Case  48.  Reported  by  Dr.  Wetter  strand.  Cultivated  Contrary  Sex- 
ual Instinct  Cured  in  Three  Weeks  by  Suggestive  Treatment. — X.  X., 
aged  34 ;  official.  "  My  parents  died  when  I  was  still  a  child.  I  then 
lived  in  a  family  the  head  of  which  was  dissipated  and  never  at  home. 
He  had  no  interest  in  his  own  children  or  in  me.  As  soon  as  I  began 
school  I  was  left  to  the  care  of  an  old  lady,  whose  habit  it  was  to  go 
about  gossiping  from  house  to  house.  Thus,  I  had  no  father.  A  tutor 
who  shared  my  room  at  night  disturbed  my  rest  by  teaching  me  unnatural 
sexual  practices.  Without  understanding  the  great  danger  of  his  con- 
duct, and  without  suspecting  the  immorality  of  his  acts,  I  offered  no 
resistance.  At  the  same  time,  I  lost  all  pleasure  in  work  and  study ;  I 
became  shy  of  my  companions  ;  associated  with  women,  and  took  part  in 
1  Der  Hypnotisrnus  und  seine  Auweudung  in  der  prakt.  Med.,  Wein,  1891,  p.  52. 


CONTRARY   SEXUAL   INSTINCT.  221 

their  work,  etc.  At  the  age  of  20  I  formed  a  close  friendship  with  a 
young  man  some  years  my  junior  (I  had  no  idea  of  anything  else),  and 
association  with  him  gave  me  great  pleasure.  I  shared  everything  with 
him,  but  there  was  nothing  immoral  in  our  relation  ;  strange  to  say,  I 
took  great  pleasure  in  flattery.  Parting  with  my  friend  was  very  hard 
for  me.  Since  then  I  have  never  felt  so  lively  an  interest  in  any  one ; 
still,  I  love  to  see  finely-formed  men,  and  should  prefer  to  see  them 
naked.  One  day,  a  woman  may  excite  me  to  lustful  feeling ;  the  next,  I 
may  have  the  same  sensations  with  a  man.  Dreams  of  both  males  and 
females  have  caused  me  to  have  pollutions.  In  the  second  coitus  I 
acquired  gonorrhoea,  I  believe,  because  I  was  not  able  to  complete  the 
act.  Besides,  I  fancy  that  I  suffer  with  impotence  and  cannot  complete 
coitus,  because  sexually  I  am  not  constituted  like  others." 

Patient  has  a  stately  figure,  is  masculine  in  his  whole  appearance, 
and  physically  well  formed.  In  a  week  he  was  transformed  by  treatment. 
Coitus  was  successful.  I  can  definitely  assert  that  when  he  left  he  was 
entirely  cured,  and  that  after  treatment  for  three  weeks, — from  Feb- 
ruary 1  to  23,  1891.  He  is  about  to  marry,  as  his  letter  of  July,  1891, 
informs  me. 

Case  49.  Reported  by  Dr.  Wetter  strand.  Contrary  Sexual  Instinct 
Cured  by  Suggestive  Treatment  in  Two  Months. — X.  X.,  aged  20.  "  Since 
my  earliest  childhood  I  have  been  inclined  to  everything  feminine. 
When  a  small  child  I  played  with  dolls,  and  I  preferred  to  associate  with 
girls,  while  I  avoided  bo3rs' games.  As  I  grew  older,  at  14  or  15, 1  began 
to  love  certain  men ;  my  weakness  was  especially  strong,  handsome  men. 
I  have  loved  many  such.  Three  times  I  was  violently  in  love,  the  last 
time  three  years  ago.  In  order  to  avoid  betraying  myself,  I  was  forced 
to  avoid  the  last  object  of  my  affections.  I  have  always  been  inclined 
by  nature  to  be  retiring.  At  that  time  I  became  melancholic  and  came 
near  suicide,  for  I  feared  insanity.  My  sleep  is  disturbed  by  dreams.  I 
practiced  onanism  passionately,  thinking  of  the  male  object  of  my  love 
during  the  act.  This  has  been  my  habit  as  long  as  I  can  remember.  I 
often  sought  to  escape  from  this  dangerous  habit,  but  in  vain.  I  always 
relapsed.  Filled  with  despair,  I  wept  and  prayed,  and  for  two  months  I 
have  not  masturbated.  I  have  never  had  congress  with  women.  I  was 
a  poor,  eldest  child,  improperly  reared,  and  the  evil  in  whose  grasp  1  am 
was  allowed  to  develop  unhindered.  I  am  poor  and  live  in  America.  I 
suffered  terrible  misery.  At  the  present  time  I  am  in  Sweden,  to  bid  my 
old  mother  farewell.  Thus  I  heard  of  you.  My  hope  was  awakened  ; 
perhaps  I  can  become  a  new  man." 

To  these  biographical  notes  by  the  patient  Wetterstrand 
adds  the  following : — 

On  his  second  visit,  January  4,  1891,  the  patient  gave  me  the  fore- 


222  SEXUAL    PAR.ESTHESIA. 

going  statement.  The  physical  examination  was  negative.  The  body 
is  well  formed ;  nothing  feminine  to  be  noticed ;  genitals  well  devel- 
oped. Another  physician  had  made  some  attempts  to  hypnotize  him. 
Thus  the  difficulty  of  affecting  him  was  increased.  Still,  I  succeeded 
in  inducing  deep  sleep  with  amnesia.  I  asked  the  patient  for  a  report 
by  letter,  and  he  sent  me  the  following  in  the  early  part  of  February  : 
"During  the  first  two  weeks  I  could  notice  no  change,  but  gradually 
my  feelings  were  altered.  ...  I  would  ask  myself,  '  Is  not  your 
body  like  that  of  other  men?  Certainly;  all  else  depends  upon  your 
imagination  which  rules  you.'  At  such  times,  it  seems  the  most  natural 
thing  in  the  world  that  I  am  a  man ;  I  am  delighted,  but  I  am  not 
capable  of  feeling  love  for  women.  I  am  satisfied,  courageous,  and  full  of 
hope.  The  soft,  feminine  heart  is  gone ;  I  now  abhor  men  ;  I  see  in  them 
my  own  image,  and  I  can  no  longer  love  them  as  I  once  did."  The  pa- 
tient left  in  the  latter  part  of  February,  entirely  recovered.  Since  then 
I  have  heard  no  more  of  him.  This  case  is  interesting,  because  the 
patient  was  still  so  young,  and  because  the  treatment  was  begun  so  early. 

Case  50.  Reported  by  Professor  Bernheim.  Inversion  of  the 
Sexual  Instinct.  Impotence  of  Seven  Years1  Duration  in  Marital 
Relations.  Cured  by  Suggestion  in  Twenty  Days. — Mr.  von  X.,  from 
Hungary,  aged  36  years,  consulted  me  May  24,  1889,  on  account  of  im- 
potence caused  by  contrary  sexual  instinct.  The  sexual  inversion  has 
existed  since  early  youth,  and  was  developed  by  vicious  practices  at 
school.  Before  his  marriage,  however,  he  was  still  able  to  have  normal 
sexual  congress  quite  often.  He  married  his  present  wife  for  love  at  the 
age  of  29  years,  but  for  seven  years  he  has  not  been  able  to  perform  the 
sexual  act  with  her.  It  was  impossible  for  him  to  have  erection  in  her 
presence,  or  even  in  the  presence  of  other  women.  On  the  other  hand, 
he  manifested  a  marked  inclination  for  men,  which  showed  itself  by  erec- 
tions. He  found  satisfaction  in  embraces  merely.  He  performed  the 
unnatural  sexual  act  but  twice.  Until  his  eighteenth  year  he  had  been 
a  moderate  onanist,  but  then  gave  up  the  vice.1 

The  patient  appears  intelligent;  lymphatic;  nervous.  Has  been 
healthy  until  now.  A  well-bred,  moral  man,  he  suffers  unspeakably 
owing  to  his  condition.  His  efforts,  persevered  in  for  years,  to  over- 
come his  unhappy  anomaly  have  been  vain.  There  is  a  constant  burden 
on  him.  All  methods  of  treatment  to  which  he  has  had  resort — every- 
thing he  has  done  to  overcome  it — have  been  without  result. 

From  May  24th  I  hypnotized  him  daily.  On  the  first  day  he 
easily  fell  asleep.  Catalepsy  ;  automatic  turning  ;  memory  after  waking. 
In  the"  third  sitting  he  fell  into  deep  sleep,  with  amnesia.  I  suggested  to 
him  the  occurrence  of  erections  in  the  presence  of  his  wife  and  the  com- 
plete disappearance  of  the  sexual  inversion.  These  suggestions  were 

1  Bernheim  :  Hypuotisine,  Suggestion,  etc.    Paris,  1891,  Obs.  38. 


CONTRARY   SEXUAL   INSTINCT.  223 

daily  repeated  energetically.  After  a  few  days  I  gave  him  the  definite 
assurance  that,  on  the  night  of  June  3d,  spontaneously  an  erection 
would  occur,  as  well  as  a  lively  desire  for  indulgence ;  and,  in  fact,  on 
the  night  of  the  3d  he  had  an  erection,  but  it  did  not  last  long  enough  to 
make  coitus  possible.  Repetition  of  the  suggestion  during  the  following 
days.  A  new  trial  is  set  for  June  8th.  Erection  occurred  and  lasted 
longer,  but  not  long  enough.  At  the  same  time  the  patient  becomes 
convinced  that  he  will  attain  his  object.  Trial  set  for  June  13th. 

On  this  occasion  he  actually  attained  his  desire.  He  said  he  per- 
formed the  act  of  marital  intercourse  easily  and  satisfactorily,  but  still 
not  in  obedience  to  an  irresistible  impulse.  The  inclination  for  men 
diminishes,  bnt  does  not  disappear  entirely. 

Patient  is  happy  at  his  success.  On  June  16th,  for  which  date 
repetition  of  the  trial  is  set  by  suggestion,  he  did  not  yield  to  the  com- 
mand, because  bethought  of  himself  as  a  satiated  man  without  inclination 
to  either  sex.  I  suggested  a  trial  for  the  coming  night. 

On  June  17th  he  told  me  of  his  success  in  the  preceding  night.  He 
awoke  with  erection,  without  any  suspicion  of  the  suggestion  that  had 
been  given  him,  and  felt  a  strong  desire  for  his  wife.  At  present  he  is 
indifferent  toward  men  ;  however,  he  is  not  sure  that  he  would  be  able 
to  withstand  temptation. 

I  now  suggest  to  him  gradual  increase  of  his  sexual  inclination  for 
his  wife,  and  order  the  next  performance  of  his  conjugal  duty  for  the 
night  of  June  19th  to  20th.  Remarkabljr  favorable  success  of  the  sug- 
gestion. His  preference  for  unnatural  indulgence  he  says  is  entirely 
gone. 

He  remained  eight  days  longer  in  Nancy,  and  during  this  time  had 
congress  with  his  wife  twice,  with  increasing  desire.  He  experienced  a 
complete  inner  transformation,  and  could  no  longer  understand  his  previ- 
ous taste  in  sexual  matters.  I  later  learned  that  the  cure,  both  physical 

and  mental,  had  continued  permanent. 

> 

Case  51.  Reported  by  Professor  Berriheim.  Contrary  Sexual  In- 
stinct Improved  by  One  Month  of  Hypnotic  Treatment. — A  young  foi'- 
eigner,  aged  23,  of  good  family,  consulted  me  four  years  ago  on  account 
of  his  passion  for  smoking,  of  which  he  wished  to  be  freed.  I  put  him 
to  sleep  (catalepsy ;  automatic  movements;  memory  after  waking).  After 
only  nine  sittings  he  regarded  himself  cured.  At  any  rate,  he  no  longer 
had  any  thought  to  smoke.  Then  he  confessed  to  me  that  he  had 
another  anomaly,  which  he  had  previously  been  too  shy  to  confess, — 
namely,  an  inversion  of  the  sexual  instinct.  For  several  years  he  had 
indulged  in  contrary  sexual  intercourse,  following  his  natural  bent.  He 
had  never  had  any  feeling  for  women,  though  he  liked  to  associate  with 
ladies.  On  the  other  hand,  his  contrary  sexual  inclinations  began  spon- 
taneously, without  anything  of  the  kind  having  been  suggested  to  him 


224  SEXUAL    PAR^ESTHESIA. 

in  school  or  elsewhere.  According  to  his  statement,  he  had  always 
fought  against  this  impulse,  which,  as  a  man  of  honor  and  good  educa- 
tion, he  was  forced  to  regard  as  evil. 

The  patient  is  intelligent,  not  eccentric,  and  without  nervous  symp- 
toms or  hereditary  antecedents  of  any  kind.  For  a  month  he  was  treated 
daily  by  suggestion.  I  sought  to  give  him  in  hypnosis  natural  feeling 
for  women  and  disgust  for  male-love.  After  three  weeks  of  treatment  he 
had  sexual  congress  with  a  woman,  without  special  inclination,  but  still 
without  aversion,  which,  up  to  that  time,  had  been  impossible  for  him. 
He  then  declared  himself  indifferent  toward  the  male  sex,  though  having 
no  aversion  for  men.  Whether  the  cure  was  permanent  or  not  I  do  not 
know. 

Case  52.  Eeported  by  Professor  Bernheim.  Imperative  Ideas  of 
Contrary  Sexual  Content  Treated  by  Suggestion  without  Result. — A  pro- 
fessor, aged  about  34,  foreigner,  consulted  me  three  years  ago  on  account 
of  imperative  ideas  of  a  sexual  nature.  According  to  his  statement, 
when  teaching  boys,  as  soon  as  he  noticed  their  limbs  and  bodies,  he  was 
seized  by  obscene  ideas  of  an  homo-sexual  nature.  He  could  not  explain 
this  inclination,  and  sought  in  vain  to  free  himself  from  such  ideas. 
With  irresistible  persistence  this  always  recurred.  It  required  all  his 
strength  to  resist  the  impulse  to  realize  such  desires. 

The  patient  had  a  good  constitution  ;  was  not  nervous  or  tainted 
hereditarily,  and  had  had  no  disease  previously.  His  honor  could  not 
be  doubted ;  his  morality  was  irreproachable.  He  was  not  subject  to 
states  of  sexual  excitement  except  at  sight  of  boys.  His  sense  of  right 
and  mor.ils  was  pained  by  these  struggles.  He  could  stay  in  Nancy  but 
a  week.  I  hypnotized  him  eight  times  (second  degree),  but  without  any 
therapeutic  result. 

Case  53.  Reported  by  Dr.  Franz  Muller.1  Homo-sexual  Ideas  Over- 
come in  One  Hypnotic  Sitting. — A  finely-educated  man,  physically 
healthy,  suffered  with  sexual  perversion.  His  thoughts  were  of  how  he 
could  bring  about  a  union  with  a  person  of  his  own  sex.  He  had  not  yet 
attained  his  desire ;  but  the  continual  struggle  against  these  ideas,  which 
in  his  heart  he  detested,  had  made  him  nervous  and  injured  his  health. 
He  was  depressed,  retiring,  and  taken  with  thoughts  of  suicide.  By 
long  treatment  with  warm,  moist  packs,  followed  by  cold  friction  and 
sitz-baths,  the  nervous  symptoms  were  fairly  overcome.  The  advice  to 
attempt  coitus  was  not  followed,  because  of  lack  of  determination. 
While  the  patient  lay  in  the  pack  and  was  inclined  to  sleep,  suggestive 
induction  of  sleep  by  Dr.  Muller,  after  fixation  had  proved  unsuccessful. 
Suggestion:  "After  your  return  home,  you  will  seek  to  satisfy  your 
sexual  desires  in  the  natural  way.  You  will  surely  succeed." 

Awakened  by  verbal  suggestion.  After  waking,  the  patient  says 
1  Comp.  Muller,  Hydrotherapie,  Leipzig,  1890,  p.  309. 


CONTRARY   SEXUAL   INSTINCT.  225 

he  has  been  asleep,  and  he  knows  nothing  of  the  suggestion.  Complete 
amnesia  on  succeeding  days.  Two  days  after  the  patient  left,  a  telegram 
announced  that  the  attempt  had  been  successful.  Since  then  regular 
sexual  intercourse  has  been  indulged  in,  and  the  former  imperative  ideas 
have  diminished  in  intensity,  though  they  exceptionally  manifest  them- 
selves. 

All  the  physician's  advice  while  the  patient  was  in  the  institution 
had  no  influence  on  him.  With  the  best  will,  he  could  not  bring  himself 
to  follow  the  advice.  What  the  most  careful  ps3rchical  treatment  in  the 
waking  state  could  not  accomplish  by  daily  repetition  was  attained  by  a 
single  suggestion  in  the  state  of*  somnambulism.  The  foregoing  case 
controverts  the  view  of  those  writers  (Benedict,  for  example)  who  assert 
that  the  same  results  can  be  obtained  by  treating  the  patient  in  the 
waking  state  as  by  hypnotic  suggestion. 

Case  54.  Reported  by  Prof,  von  Krafft-Ebing.  Contrary  Sexual 
Instinct  Treated  without  Success  in  One  Hypnotic  Sitting. — Male,  aged 
34,  merchant.  Full  beard  ;  mincing,  feminine  gait.  He  neither  smokes 
nor  drinks.  Moody,  nervous,  devoid  of  moral  feeling ;  disinclination  for 
masculine  pursuits.  At  12,  excited  by  tight-fitting  uniforms.  Follows 
men  of  muscular  build  for  hours.  Onanism  accompanied  by  thoughts  of 
heroic  men.  Knowledge  of  his  condition  at  17.  He  then  had  congress 
with  women  eight  or  ten  times,  but  erection  occurred  only  at  thought  of 
men.  Later  this  was  no  longer  successful.  Very  sensual  nature.  Un- 
usually cynical  and  inventive  in  imagining  situations  of  which  homo- 
sexual intercourse  is  the  subject.  Ejaculation  has  been  induced  as  many 
as  five  or  six  times  in  a  night  by  this  means.  Soldiers  are  preferred. 
Patient  feels  entirely  like  a  woman. 

Parents  health}' ;  one  brother  an  urning.  An  attempt  to  hypnotize 
the  much-excited  patient  induces  but  slight  somnolence. 

Case  55.  Reported  by  Prof,  von  Krafft-Ebing.  Contrary  Sexual 
Instinct  Acquired  through  Masturbation.  Much  Improved  in  Eight 
Hypnotic  Sittings. — X.,  aged  29  ;  merchant.  Father  irritable ;  mother 
had  a  rough,  masculine  voice,  and  died  in  childbed.  Brother  of  patient 
irritable,  melancholic,  and  neutral  toward  women. 

The  first  trace  of  sexual  feeling  occurred  in  his  tenth  to  eleventh 
year.  He  learned  onanism  from  other  boys,  and  practiced  mutual  mas- 
turbation. First  emission  at  the  age  of  13  or  14;  after  his  twentieth 
year,  pollutions,  in  spite  of  daily  onanism.  With  the  pollutions,  dreams 
of  sexual  congress. 

Seduced  into  mutual  onanism  in  his  seventeenth  year.  Satisfac- 
tion in  it,  but  without  love;  passive  role.  After  that  he  thought  of  the 
hand  of  a  man  in  auto-masturbation.  Previously,  erections  at  sight  of 
an  attractive  woman.  Coitus  avoided  for  fear  of  infection.  Later,  his 
dreams  contained  only  male  forms. 

15 


226  SEXUAL    PA1LESTHESIA. 

Patient  is  a  gymnast ;  smokes,  drinks  beer,  skates.  Since  June, 
1889,  neuralgia  of  the  testicles,  mainly  at  night.  Fear  of  onanism. 
Hope  of  restoration  sexually.  No  masturbation  for  five  days.  Disincli- 
nation to  work ;  depression.  Body  well  nourished ;  without  sign  of  dis- 
ease. Von  Krafft-Ebing  quieted  him,  and  enjoined  him  to  turn  his  sexual 
feeling  from  men  to  women.  Prescription  of  half-baths  (24°  to  30°  R.). 
Ext.  ergot,  aquos.,  0.5  ;  antipyrin,  1.0,  daily;  pot.  bromidi,  4.0,  at  night. 

December  13th.  The  patient  cannot  resist  his  impulse  to  mastur- 
bate. Attempt  at  hypnosis  induces  deep  lethargy.  Suggestions  :  1.  I 
cannot  and  must  not  masturbate.  2.  I  abhor  love  of  my  own  sex,  and 
shall  think  no  man  handsome.  3.  I  will  and  shall  become  healthy,  love 
a  virtuous  woman,  be  happy,  and  make  her  happy. 

Somnambulism  in  the  fourth  sitting.  In  the  eighth  sitting,  full 
virility  is  added  as  a  suggestion.  The  patient  feels  morally  elevated  and 
physically  strengthened.  Neuralgia  of  the  testicles  gone.  Absence  of 
sexual  feeling.  He  now  thinks  himself  free  from  masturbation  and  con- 
trary sexual  feeling.  He  feels  healthy  and  potent.  Discharged  in 
January,  1890. 

In  March,  1890,  the  patient  wrote  that  on  several  occasions  it  had 
been  necessary  for  him  to  exert  all  his  moral  strength  to  overcome  his 
habit,  but  he  had  succeeded  in  keeping  free  from  it.  He  had  performed 
coitus  a  few  times  with  moderate  pleasure.  He  looked  confidently  on  his 
future. 

Case  56.  Reported  by  Prof,  von  Krafft-Ebing.  Acquired  Contrary 
Sexual  Instinct  Cured  by  Suggestion.  Two  Relapses  Overcome  by  Sug- 
gestion.— Z.,  aged  32;  divorced.  Mother  hysteropathic ;  maternal  grand- 
mother hysterical,  and  her  brothers  and  sisters  were  subject  to  nervous 
troubles.  Patient's  brother  nervous.  Z.  poorly  endowed ;  at  13  taught 
onanism  by  a  schoolmate.  Sexual  hyperaesthesia.  Coitus  at  17  with 
pleasure  and  power.  Married  at  26  for  reasons  of  standing  and  fortune. 
Unhappy  marriage.  Wife  incapable  of  congress,  after  a  few  years,  owing 
to  uterine  disease.  Z.  indulged  himself  with  other  women;  faate  de 
mieux,  with  masturbation.  Dissolute  life.  He  drank  and  gambled. 
Severe  neurasthenia.  Cerebral  asthenic  symptoms — spasms  of  laughing 
and  crying ;  globus.  Libido  nimia  undiminished.  Disgust  for  prosti- 
tutes ;  fear  of  infection.  Exceptionally,  indulgence  in  coitus ;  usually,  in 
onanism. 

During  the  last  four  years  increasing  weakness  of  erection ;  decreas- 
ing libido  for  women.  Dreams  of  men  and  other  contrary  sexual  incli- 
nations. Three  years  ago  masturbation  by  a  bath-attendant  on  the 
occasion  of  massage.  Prom  that  time  absolute  indifference  for  women. 
He  now  slept  with  men.  Mutual  masturbation.  Pederasty  abhorred. 
Warned  by  an  anonymous  letter.  Remorse;  thoughts  of  suicide ;  intense 
shame. 


CONTRARY   SEXUAL   INSTINCT.  227 

First  thought :  Sexual  rehabilitation  in  his  own  eyes.  Coitus  in  a 
brothel,  which,  in  spite  of  great  difficulties,  was  finally  successful.  The 
unchanged  contrary  sexual  feelings  sent  the  patient  to  Prof,  von  Krafft- 
Ebing.  Comforting  assurances.  Prospect  of  help  quieted  him.  No 
signs  of  degeneration  (slightly-retreating  brow) ;  spinal  irritation ;  in- 
creased deep  reflexes;  pressure  in  head.  Disturbed  facial  expression; 
relaxed  attitude.  Unrestrained  state  of  mind.  Half-baths ;  rubbings ; 
ergot  with  antipyrin ;  bromides ;  abandonment  of  onanism  and  male 
intercourse  and  lascivious  thoughts  of  men. 

Since  the  patient's  will  proved  too  weak  for  this,  hypnotic  treatment 
was  begun  September  11,  1889.  Suggestions  :  Coitus  once  a  week  with 
full  power  ;  disinclination  for  men  ;  inclination  for  women  ;  abandonment 
of  onanism.  Patient  repeats  the  suggestions.  Sitting  every  second  day. 
From  September  15th  somnambulism  with  possibility  of  any  post-hypnotic 
phenomena  desired.  Gradual  improvement. 

September  24th.  Patient  is  free  from  onanism  and  no  longer  ex- 
citable to  men,  but  to  women.  Normal  coitus.  Hysterical  symptoms 
gone  ;  neurasthenic  symptoms  lessened. 

October  6th.     The  patient  wrote  of  his  good  health. 

December  9th.  Treatment  resumed.  Lascivious  dreams  of  men 
twice,  but  no  inclination  toward  men  while  awake.  He  had  resisted  the 
inclination  to  onanism,  though  living  in  the  country  and  having  no  oppor- 
tunity for  sexual  congress.  Dreams  of  hetero-sexual  content.  Cured  by 
three  sittings. 

Second  relapse  in  September,  1890.  Antineurasthenic  treatment 
and  hypnosis  again  restore  the  patient.  As  stated  by  the  author,  Oc- 
tober, 26,  1891,  the  cure  remained  permanent.  The  patient  never  mas- 
turbated again,  and,  according  to  a  communication  of  October  19,  1891, 
he  but  seldom  has  homo-sexual  thoughts  while  awake,  though  sometimes 
in  dreams. 

Case  57.  Reported  by  Prof.  v.  Krafft-Ebing.  Congenital  Contrary 
Sexual  Instinct.  Successful  Removal  of  Homo-sexual  Feelings  by  Hyp- 
notic Suggestion. — L.,  Ph.D.,  consulted  me  in  February,  1888,  for  per- 
verse tendency  of  his  vita  sexualis,  and  wished  to  be  freed  from  it  by 
means  of  hypnosis.  Mother  healthy.  Patient  resembles  his  father  phys- 
ically. Brother  very  passionate  sexually,  abnormal  mentally,  and  given 
to  drink.  Father  neuropathic  and  eccentric ;  likewise  given  to  drink. 
Paternal  grandmother  was  a  notorious  drinker. 

Patient  from  childhood  nervous,  excitable.  Talent  for  languages, 
art,  poetry,  and  music.  Excellent  education.  At  the  age  of  13  his 
father  warned  him  against  handling  his  genitals.  The  sight  of  syphilitic 
pictures  in  an  anatomical  museum  excited  his  horror,  and,  in  L.'s  opinion, 
was  the  cause  of  his  later  fear  of  intercourse  with  women.  The  principal 
cause  of  the  perversion  of  his  vita  sexualis  the  patient  seeks  in  a  naturally 


228  SEXUAL    PAILESTHESIA. 

defective  disposition.  Even  when  a  small  boy  he  says  he  had  enthusiastic 
partiality  for  his  companions.  He  also  remembers  that  at  that  time  his 
interest  was  in  feminine  games  only,  and  that  he  preferred  to  be  in  the 
company  of  girls.  He  did  knitting  and  embroidery  passionately  when  a 
boy.  Still  ignorant  sexually,  at  14  he  fell  into  the  hands  of  a  pederast, 
and  he  fled  as  soon  as  he  discovered  what  the  man  intended  to  do  with 
him.  When  he  was  15  a  certain  sympathetic  school-mate  was  accustomed 
to  lay  his  head  in  the  patient's  lap.  He  experienced  a  strange  lustful 
pleasure  in  this  which  he  could  not  understand.  At  16,  the  first  erec- 
tion a*  sight  of  men. 

At  20  the  patient  recognized  h,is  condition.  His  love  was  directed 
to  youthful  men  of  the  higher  classes  of  society.  Hetero-sexual  charms 
neither  excited  L.,  nor  did  they  give  him  any  satisfaction.  Only  when 
15  had  he  had  a  few  dreams,  with  lustful  feeling,  about  a  girl  of  voluptu- 
ous figure  sitting  opposite  him  on  a  sofa.  At  the  theatre  he  admired 
only  the  art  of  actresses ;  his  interest  was  excited  by  the  actors.  No 
inclination  to  drink,  smoke,  or  hunt ;  nor  for  athletics  or  other  manly 
pursuits.  Released  from  military  service  by  reason  of  general  physical 
weakness. 

Patient  has  small  sexual  appetite.  Some  years  ago,  when  a  man 
sought  to  embrace  him  lovingly,  there  was  erection  and  lustful  excite- 
ment, but  he  controlled  himself  and  repelled  the  lover.  No  onanism.  A 
condition  of  irritable  weakness  showed  itself,  some  years  previously,  in 
ejaculations  whenever  an  attractive  man  embraced  the  patient.  Attempt 
at  coitus  in  a  brothel  a  complete  failure.  Other  attempts  with  the  assist- 
ance of  imagining  men  were  likewise  unsuccessful.  Patient  saw  that  he 
could  not  attain  his  ideal, — marriage, — and  was  very  unhappy  at  his 
painful  state.  Masculine  appearance ;  abundant  beard ;  slight  neuras- 
thenic symptoms  ;  nothing  else  worthy  of  note. 

The  patient  is  shown  the  deep  constitutional  significance  of  his 
sexual  anomaly.  He  wishes  to  have  his  sexual  excitability  to  men,  at 
least,  lessened  by  hypnotic  treatment. 

Hypnotized  by  Bernheim's  method.  The  patient  passes  into  deep 
lethargy.  In  a  drawling  tone,  he  repeats  the  suggestion :  "  I  feel  that, 
from  this  time  forth,  I  am  sexually  indifferent  to  men ;  that  men  are 
sexually  as  indifferent  to  me  as  women."  Post-hypnotic  suggestion 
succeeds,  though  consciousness  is  partly  retained.  Return  of  energy 
and  will  after  five  days.  Unmistakable  change  in  the  patient's  manner. 

Hypnotized  on  the  following  seven  days.  But  hypnosis  is  not  so 
deep  as  at  the  first  sitting.  Suggestions  of  the  same  nature  are  given 
and  accepted.  Suggestion  to  awake  necessary.  After  eight  sittings 
the  patient  regards  himself  again  in  full  possession  of  his  self-confidence. 

L.  thinks  he  can  dispense  with  hypnotic  treatment,  and  gratefully 
takes  his  leave,  with  the  promise  to  return  as  soon  as  the  power  of  the 


CONTRARY    SEXUAL   INSTINCT.  229 

hypnotic  suggestion  diminishes.  Nothing  more  has  been  heard  from  the 
patient. 

Case  58.  Reported  by  Prof,  von  Krofft-Ebing.  Efffniination. 
Single  Hypnosis  without  Effect. — Y.,  aged  30  ;  official.  Parents  healthy. 
When  a  child  he  wore  girls'  clothes,  loved  doll-play,  etc.  At  12,  mastur- 
bation in  imitation  of  a  companion.  When  a  youth  he  coquetted  with 
men.  Horror  feminae.  Attempts  at  coitus  devoid  of  erection,  even 
with  the  help  of  the  puella.  Early  abandonment  of  efforts  to  have 
hetero-sexual  intercourse.  Patient  is  dead  in  love  with  a  man  who 
ignores  him  and  courts  women.  Thoughts  of  suicide.  He  abhors  male- 
love.  Beside  himself  with  lust  at  the  sight  of  a  virile  member. 

In  dreams  he  saw  only  male  forms.  Satisfaction  only  in  masturba- 
tion. The  patient  thinks  himself  a  man  with  a  woman's  brain.  Great 
delight  in  wearing  female  garments.  Ashamed  to  undress  before  a  man. 
Abundant  beard.  Features  approach  the  feminine  type.  Manner  mas- 
culine. Neither  smokes  nor  drinks.  Pelvis  broad,  feminine ;  abundant 
adipose.  Right  testicle  atrophic  (orchitis  after  typhus).  Genitals  well 
formed. 

Fear  of  hypnotic  treatment,  but  still  wishes  to  be  transformed  sex- 
ually. Indifference  to  men  would  suffice  him.  Attempt  at  hypnosis  an 
absolute  failure. 

Case  59.  Reported  by  Dr.  Ladame  (Geneva).  Successful  Treat- 
ment of  Sexual  Inversion  by  Means  of  Hypnotic  Suggestion. — X.,  aged 
33  years;  single;  tall;  small  mental  endowment;  from  tainted  family. 
Father  died  of  mental  disease  at  34  years  of  age,  due  to  onanism  and 
spermatorrhoea.  The  patient's  father  and  brother  both  had  disturbance 
of  the  sexual  functions.  Mental  disease  on  the  maternal  side.  Other 
members  of  the  family  were  known  for  their  irritable,  eccentric  char- 
acter. 

The  patient  has  a  small  head,  retreating  brow,  abnormal  ears,  slight 
growth  of  beard;  hernia,  probably  congenital.  Great  impressionability; 
neuropathic  constitution ;  occasional  taedium  vitae.  For  several  years 
strange,  imperative  ideas  of  being  a  locomotive,  a  horse,  a  bicycle,  with 
impulse  to  act  accordingly.  Since  earliest  youth,  at  least,  congenital 
contrary  sexual  instinct.  Horror  feminae;  sexual  inclination  toward 
boys.  Gratification  in  lustful  handling ;  faute  de  mieux,  masturbation  ; 
occasionally,  also,  active  and  passive  pederasty.  One  day  he  had  an 
affair  with  a  boy  dressed  in  gray  that  made  a  deep  impression  on  him. 
After  that  he  reveled  in  the  fancy  of  a  loved  boy  dressed  in  gray  while 
masturbating;  and  he  could  not  see  gray  garments  without  having 
powerful  erections.  In  attempts  at  coitus  inexcitable  and  impotent,  in 
spite  of  the  help  of  thinking  of  a  boy  dressed  in  gray. 

March  27,  1889,  first  attempt  at  hypnosis.  Slight  success.  The 
patient  resists,  and  says  his  fancies  keep  him  from  going  to  sleep.  In  a 


230  SEXUAL    PAR^ESTHESIA. 

series  of  further  sittings  he  declares  he  feels  an  unfavorable  influence ; 
that  he  is  more  troubled  with  imperative  ideas  and  impulse  to  mastur- 
bate. He  makes  fun  of  the  physician  and  hypnotism  and  makes  ener- 
getic resistance,  stating  that  hypnosis  is  of  no  use  and  only  makes  people 
crazy.  Nevertheless,  somnambulism  is  gradually  induced.  After  twenty- 
five  sittings  the  patient  confesses  that  he  is  better;  that  he  has  fewer  im- 
perative ideas,  and  is  less  troubled  with  onanism. 

Continuance  of  the  sittings  every  week  or  two.  The  patient  feels 
well  physically  and  morally  and  ceases  to  masturbate,  but  at  the  cessation 
of  treatment  is  still  indifferent  to  the  opposite  sex. 

ALGOLAGNY. 

Case  60.  Reported  by  Dr.  Moll,  Berlin.  Sadism;  Improved  by 
Hypnotic  Treatment  Continued  Ten  Weeks.— L.  T.,  aged  25;  merchant; 
hereditary  taint.  Quiet,  retiring.  Sexual  desire  began  at  the  age  of  7. 
Indulgence  in  masturbation,  during  which  the  patient  fancied  he  was 
beating  a  woman  on  the  nates  with  a  rod  until  ridges  were  raised,  in  order 
that  she  might  feel  his  power  over  her.  Neither  libido  nor  erection  on 
the  first  attempt  at  coitus  ;  the  second  likewise  a  failure.  He  forced  the 
woman  to  allow  him  to  beat  her.  While  he  was  striking  her  the  woman 
cried  out  with  pain,  when  erection,  orgasm,  and  ejaculation  occurred. 
While  beating  the  woman  he  took  her  between  his  knees  so  that  his  mem- 
brum  virile  touched  her  body,  but  without  immissio  penis  in  vaginam.  He 
continued  to  perform  active  flagellation.  Passive  flagellation  also  in- 
duced ejaculation,  he  thought,  without  erection.  The  thought  of  beating 
men  in  dreams  also  induced  pollution.  In  the  first  situation  this  idea 
caused  him  little  excitement. 

Dr.  Moll  treated  the  patient  three  months  and  a  half.  He  advised 
him  never  to  give  himself  voluntarily  to  such  ideas,  but  to  divert  his 
thoughts  and  think  of  nude  women.  Treatment  for  two  months  and  a 
half  with  hypnotic  suggestion  caused  the  perverse  ideas  to  occur  less 
frequently,  and  erection  occurred  often  at  the  thought  of  nude  women, 
leading  to  onanism  with  accompanying  thought  of  coitus.  Four  attempts 
at  coitus.  Dr.  Moll  advised  increasing  sexual  excitement  with  tincture 
of  cantharides.  At  the  first  attempt  prolonged  manipulation  by  the 
woman  was  necessary  to  induce  erection  ;  then  followed  the  performance 
of  the  act  without  thought  of  flagellation.  Second  attempt  still  more 
successful.  On  the  third  trial  coitus  was  successful  only  after  thought 
of  flagellation,  but  there  were  no  blows.  On  the  fourth  attempt  the  act 
was  successful  without  manipulation  or  thought  of  flagellation.  The 
performance  of  coitus  in  a  way  nearly  normal  does  not  signify  a  cure, 
and  gives  no  guarantee  for  the  future ;  for  the  thought  of  flagellation 
still  has  a  great  charm  for  the  patient,  though  it  occurs  less  frequently 
than  formerly.  Still,  it  is  possible  that  the  abnormal  impulse,  which  is 


ALGOLAGNY.  231 

essentially  weakened,  will  remain  so  in  the  future,  and  perhaps  dis- 
appear. 

Case  61.  Reported  by  Prof,  von  Krafft-Ebing.  Masochism;  Im- 
proved by  Suggestion. — X.,  aged  30.  Father  died  by  suicide.  Mother 
suffered  with  periodical  mental  disturbance.  At  14,  abnormal  sexual 
inclinations.  Punishment  at  the  hands  of  boys  of  his  own  age  induced 
lustful  feelings,  especially  blows  on  the  nates.  The  same  ideas  accom- 
panied daily  onanism,  which  was  practiced  till  his  eighteenth  year. 
Young,  handsome  men,  aged  from  20  to  22,  wearing  close-fitting  trousers, 
young  officers  and  hussars,  for  the  most  part,  played  the  roles  in  his 
thoughts  of  flagellation.  Sexual  dreams  of  similar  content  and  pollu- 
tions. Women  were  always  a  matter  of  indifference  to  him,  though  he 
felt  no  disgust  at  female  nudity.  Two  attempts  at  coitus  were  attended 
only  with  traces  of  erection.  In  spite  of  his  want  of  success,  he  was  not 
repelled  by  the  act  of  tying  near  a  puella.  The  patient  is  a  skillful 
dancer.  Unhappy  about  his  false  existence.  Thoughts  of  suicide. 
Great  love  of  family  life.  His  only  hope  lies  in  cure  by  hypnosis.  At 
his  first  meeting  with  Prof,  von  Krafft-Ebing  the  patient  adds  the  follow- 
ing notes.  He  remembers  distinctly  that  when  he  once  saw  a  school- 
mate beaten  by  the  teacher  it  caused  him  lustful  pleasure.  Thus  his 
masochism  was  entirely  a  primary  phenomenon,  and  onanism  with 
thoughts  of  flagellation  was  indulged  in  at  first  faute  de  mieux.  When 
he  grew  up  he  had  not  been  able  to  bring  himself  to  have  his  masochistic 
inclinations  realized.  The  thought  of  being  beaten  by  a  puella  remained 
devoid  of  sexual  coloring.  Sadistic  thoughts.  He  became  enthusiastic 
about  the  position  of  teachers.  Wished  to  become  one  that  he  might 
whip  boys. 

Increased  knee-jerks ;  slight  neurasthenic  symptoms  ;  genitals  per- 
fectly normal.  Principal  features  of  treatment  :  1.  Removal  of  neuras- 
thenic troubles.  2.  Suggestive  treatment:  (a)  avoidance  of  onanism; 
(6)  indifference  for  his  own  sex,  and  disappearance  of  ideas  of  flagel- 
lation from  thought  and  dreams  ;  (c)  libido  exclusively  for  the  opposite 
sex,  the  occurrence  of  erection  at  the  sight  of  beautiful  female  forms, 
full  power  with  women,  and  dreams  of  women  exclusively.  By  Bern- 
heim's  method,  deep  lethargy  in  the  first  sitting.  In  the  second  sitting, 
cataleptiform  state  of  the  muscles.  Sittings  daily.  Stroking  the  brow 
deepens  hypnosis.  In  the  third  sitting,  first  therapeutic  suggestions,  of 
the  nature  mentioned.  After  five  days  the  patient  declares  he  no  longer 
has  any  interest  in  men,  but  in  women.  He  begins  to  dream  of  women. 

Three  days  later,  during  the  day,  the  patient  feels  entirely  free 
from  masochism,  and  without  interest  in  whips.  Still  weak  flagellation- 
dreams  of  men  at  night,  but  without  sexual  coloring  or  pollutions.  A 
short  time  ago  he  had  a  dream,  devoid  of  sexual  feeling,  to  the  effect  that 
he  was  whipping  himself.  Six  days  later,  attempt  at  coitus  with  an 


232  SEXUAL  PARJESTHESIA. 

attractive  puella.  No  ejaculation.  He  gave  up  the  effort.  Unhappy 
about  his  failure.  Still,  he  hopes  for  ultimate  success,  for  he  feels  him- 
self free  from  abnormal  thoughts  and  like  another  man.  Owing  to 
duties,  he  was  forced  to  discontinue  treatment. 

CONTRARY  SEXUAL  INSTINCT. 

Case  62.  Personal  Observation.  ( Congenital  ?)  Contrary  Sexual 
Instinct  in  an  Hereditarily-  Tainted  Neuropath.  Relative  Cure  in  Forty- 
jive  Hypnotic  Sittings.  Period  of  Observation,  Two  Years  and  Seven 
Months. — "  My  abnormality  consists,  in  brief,  of  this  :  in  sexual  matters 
I  feel  completely  like  a  woman.  Since  my  earliest  youth,  in  my  sensual 
acts  and  fancies,  I  have  had  only  images  of  males  and  male  sexual  organs 
before  my  eyes.  Until  I  went  to  the  university  I  found  nothing  remark- 
able in  this  (I  had  never  spoken  to  others  of  my  fancies ;  at  the  gymna- 
sium I  lived  rather  alone  and  retired).  At  the  university  it  struck  me 
that  the  females  did  not  excite  me  in  the  least.  Since  then,  in  brothels, 
I  have  often  made  an  attempt  to  have  coitus  or  even  an  erection  with 
women,  but  always  in  vain.  Erection  disappeared  immediately  I  was 
in  a  room  alone  with  a  woman.  At  first  I  regarded  this  as  impotence, 
though,  at  the  same  time,  I  was  so  excited  sexually  that  I  had  to  mas- 
turbate several  times  to  enable  myself  to  sleep. 

"  My  feelings  toward  the  male  sex  developed  very  differently,  and 
each  year  they  have  grown  stronger  and  stronger.  At  first  they 
expressed  themselves  in  a  feeling  of  enthusiastic  friendship  for  certain 
persons,  under  whose  windows  I  would  wait  hours  at  night,  whom  I 
would  try  in  all  possible  ways  to  meet  upon  the  street,  and  with  whom 
I  sought  to  come  in  contact  again  and  again.  I  wrote  such  persons  pas- 
sionate letters,  in  which,  however,  I  was  shy  of  expressing  my  feelings 
clearly.  Later,  during  my  years  from  20  to  30, 1  became  conscious  of  the 
sensual  nature  of  my  inclinations,  principally  through  the  lustful  feeling  I 
experienced  whenever  I  came  in  actual  contact  with  any  of  these  friends. 
These  persons  were  all  handsomely-formed  men  with  dark  hair  and  e3res. 
I  have  never  felt  myself  excited  by  boys,  and  real  pederasty  is  incompre- 
hensible to  me.  About  this  time  (twenty-second  to  twenty-third  year) 
the  circle  of  my  loved  friends  became  more  and  more  extended.  Now  I 
can  scarcely  see  a  handsome  man  without  the  wish  being  excited  in  me 
to  possess  him.  I  love  principally  persons  of  the  lower  classes,  whose 
powerful  forms  attract  me, — soldiers, policemen, car-drivers,  etc., — namely, 
all  who  wear  uniforms.  If  one  of  these  return  my  look,  I  feel  a  kind  of 
thrill  through  my  whole  body.  Evenings  I  am  especially  excitable,  and 
merely  the  powerful  tread  of  a  soldier  may  give  me  the  most  violent 
erections.  For  me  it  is  a  special  kind  of  pleasure  to  follow  such  persons 
and  look  at  them.  As  soon  as  I  learn  that  they  are  married  or  that  they 
court  girls,  my  excitement  usually  ceases.  Until  a  few  months  ago  I 


CONTRARY    SEXUAL   INSTINCT.  233 

was  able  so  far  to  control  my  inclinations  that  they  were  not  directly 
noticeable.  About  this  time,  however,  I  saw  a  soldier,  whom  I  followed, 
intending  to  obtain  my  desire,  and  I  spoke  to  him.  He  would  do  any- 
thing for  money.  I  was  immediately  seized  with  the  most  intense  desire 
to  embrace  and  kiss  him,  and  the  danger  of  discovery  could  not  restrain 
me.  He  had  scarcely  touched  my  genitals  when  ejaculation  occurred. 
With  this  meeting  I  had  reached  the  long-desired  goal  of  my  life.  I 
knew  that  my  whole  nature  would  find  in  it  happiness  and  satisfaction, 
and  I  proposed  from  this  time  to  try  to  find  a  person  whom  I  could  love 
and  from  whom  I  should  never  part.  My  acts  gave  me  not  the  slightest 
qualms  of  conscience.  Still,  in  quiet  moments,  I  feel  the  great  difference 
between  my  way  of  thinking  and  that  of  the  world  at  large ;  and  natu- 
rally, as  a  lawyer,  I  recognize  the  danger  of  the  relation  I  desire ;  but, 
as  long  as  my  whole  nature  is  not  changed,  I  shall  not  be  able  to  resist 
the  temptations  which  assail  me.  Nevertheless,  I  am  ready  to  subject 
myself  to  any  cure  to  raise  me  from  my  abnormal  state. ' 

"  That  I  feel  like  a  woman  I  also  recognize  in  the  fact  that  all 
sensual  feeling  with  a  lady  is  forced  and  seems  unnatural  to  me.  I 
am  also  certain  that  my  respect  for  a  lady — I  am  much  in  female 
society,  and  enjoy  it — would  immediately  be  changed  to  repugnance 
were  I  to  detect  in  her  any  sensual  feeling  for  me.  In  my  dreams 
and  sensual  fancies  of  men  I  always  imagine  myself  in  such  positions 
that  their  faces  are  toward  me.  My  delight  would  be  most  intense 
were  a  powerful,  naked  man  to  press  me  in  his  arms  with  a  force  I 
could  not  resist.  I  think  of  myself,  in  such  situation,  alwa3Ts  as  in  a 
passive  role,  and  I  have  to  force  n^self  to  think  myself  in  any  other  po- 
sition. In  this  I  am  truly  femininely  shy.  Great  as  my  desire  may  be 
to  approach  this  or  that  person,  my  effort  not  to  allow  this  inclinaton  to 
be  noticed  is  as  great.  Moustache,  abundant  hair,  even  dirt  are  espe- 
cially attractive  to  me.  I  need  scarcely  sa}r  that  my  condition  with  refer- 
ence to  society  seems  to  me  absolutely  desperate,  and  had  I  not  the  hope 
of  finding  a  person  who  will  understand  me  I  could  scarcely  endure  life. 
I  feel  that  sexual  intercourse  with  a  man  is  the  only  means  with  which 
to  overcome  my  impulse  to  onanism.  Though  this  vice  is  very  injurious 
to  me,  I  cannot  abstain  from  it  for  any  great  length  of  time ;  for,  as  I 
have  often  demonstrated,  when  I  thus  abstain  I  am  even  more  weakened 
by  pollutions  at  night  and  erections  by  day,  which  last  for  hours  at  a 
time. 

"  I  have  till  now  but  truly  loved  only  two  men.  Both  were  officers, 
very  bright,  handsome,  and  slim ;  of  dark  complexion,  and  with  dark  eyes. 
I  made  the  acquaintance  of  the  first  at  the  university.  I  was  insanely 
in  love  with  him,  and  suffered  unspeakably  from  his  indifference.  I  would 
spend  half  the  night  under  his  window,  only  to  be  near  him.  When  he 
was  ordered  elsewhere  I  was  in  despair. 


234  SEXUAL    PAILESTHESIA. 

"  Soon  after,  I  made  the  acquaintance  of  another  officer  resembling 
the  first,  who  likewise  enchained  me  at  first  sight.  I  sought  every  oppor- 
tunity to  be  with  him,  and  spent  the  whole  day  on  the  streets  and  about 
places  where  I  might  hope  to  catch  sight  of  him.  I  felt  the  blood  mount 
to  my  face  when  I  unexpectedly  met  him.  If  I  saw  him  friendly  with 
others  I  could  scarcely  contain  myself  for  jealousy  When  I  sat  near 
him  I  was  impelled  to  touch  him ;  if  I  touched  his  knee  or  thigh  my  ex- 
citement could  scarcely  be  concealed.  But  I  never  ventured  to  express 
my  feelings  for  him ;  for,  from  his  manner,  I  knew  he  would  not  have 
understood  or  shared  them.  I  am  27  years  old,  of  medium  size,  well 
grown,  and  am  considered  handsome.  My  chest  is  somewhat  narrow,  my 
hands  and  feet  are  small,  and  my  voice  weak.  I  think  I  have  good  mental 
capabilities,  for  I  passed  the  State  examination  with  distinction,  speak 
several  languages,  and  am  a  good  painter.  In  my  work  I  am  considered 
industrious  and  conscientious.  My  acquaintances  think  me  cold  and 
peculiar.  I  do  not  smoke  or  take  part  in  any  sport,  and  I  cannot  sing  or 
whistle.  My  gait  is  somewhat  affected,  as  is  my  speech.  I  have  much 
taste  for  elegance ;  I  love  ornament,  sweets,  and  perfumes  ;  and  I  prefer 
to  move  in  the  society  of  ladies." 

The  foregoing  autobiography  was  published  in  the  fifth 
edition  of  "  Psychopathia  Sexualis  "  as  Case  83,  and  in  the 
sixth  edition  as  Case  118,  in  connection  with  a  history  fur- 
nished by  me,  following  two  articles  which  I  published  in  the 
Internationalen  Miniscken  Rundschau,  No.  40,  1889,  and  No. 
15,  1890.  The  following  report  is  a  continuance  of  these 
reports  in  a  different  form  : — 

R.,  aged  28,  an  official,  called  on  me  January  20, 1889.  His  sexual 
perversion  seems  to  have  been  developed  upon  an  hereditary  neuropathic 
foundation.  The  paternal  great-grandfather  and  his  sister  died  insane. 
Grandmother  died  of  apoplex}^.  A  paternal  uncle  died  insane ;  his 
daughter  died  of  cerebral  tuberculosis.  Maternal  grandfather  insane ; 
a  maternal  uncle  committed  suicide  while  insane.  The  patient's  father  is 
very  nervous.  A  younger  brother  is  neurasthenic  and  affected  with 
anomalies  of  the  vita  sexualis;  another  brother  is  affected  with  contrary 
sexuality ;  a  third  is  eccentric  in  conduct,  and  is  said  to  have  fixed  ideas. 
One  sister  is  subject  to  convulsive  attacks,  and  another  died  of  convul- 
sions in  childhood. 

R.  has  never  had  coitus  with  a  woman.  The  thought  of  sexual 
intercourse  with  a  woman  is  unattractive  to  him.  However,  in  order  to 
become  master  of  his  abnormal  feelings,  by  summoning  all  his  will-power 
he  has  repeatedly  made  the  attempt  to  perform  the  sexual  act  with  a 
woman;  but  he  never  became  excited  sexually,  and  had  no  erection. 


t         CONTRARY   SEXUAL   INSTINCT.  235 

He  continued  impotent  with  women,  and  he  esteemed  the  society  of 
educated  persons  of  the  opposite  sex  only  for  their  mental  qualities. 

Impulse  and  inclination  toward  men  have  been  fully  developed 
since  the  time  of  puberty.  Merely  the  touch  of  persons  of  his  own  sex, 
in  some  cases,  increased  the  patient's  sexual  excitement  to  the  extent  of 
inducing  ejaculation.  By  masturbation  and  frequent  intercourse  with 
men  of  the  lower  classes,  whom  he  followed  at  night  on  the  streets,  he 
sought  to  satisfy  his  libido.  Hindered  by  social  and  criminal  restrictions, 
powerless  in  the  face  of  his  feelings,  the  patient  became  torn  with  inner 
contention.  Sexual  desire  and  his  better  impulses  came  in  conflict. 
Lascivious,  exciting  dreams,  in  which  men  played  the  principal  roles,  in- 
creased the  inner  struggle.  At  times  reason  conquered  ;  on  such  occa- 
sions R.  found  strength  enough  to  leave  the  society  of  men  as  soon  as  his 
passion  threatened  to  overcome  him.  As  a  rule,  however,  sexual  desire 
was  victorious.  As  a  result  R.  felt  exceedingly  unhappy.  Life  became 
a  burden.  In.  this  state  of  mental  depression  the  patient  sought  my  aid. 

January  22,  1889,  I  first  attempted  to  hypnotize  R.  by  means  of 
the  method  used  at  Nancy.  R.  became  somnolent,  and  after  a  few  days, 
by  repetition  of  the  procedure,  I  was  successful  in  inducing  hypotaxis. 
From  that  time  suggestive  catalepsy  was  induced,  but  for  the  most  part 
consciousness  was  retained.  Though  the  patient  was  able  to  recall  the 
commands  given  him  in  sleep,  still  he  was  no  longer  able  to  resist  the 
suggestions,  and  he  followed  the  inner  impulse  that  was  stronger  than 
his  will.  The  results  as  regards  appetite  and  mood  were  usually  striking. 
In  the  later  sittings  I  avoided  questions  which  would  awaken  his  memory 
after  he  awoke.  This  circumstance  and  the  gradual  deepening  of  the 
sleep,  as  well  as  the  assurance  that  he  would  have  no  memory,  later 
induced  somnambulism.  His  memory  was  either  cloudy,  defective,  or 
entirely  absent.  Always  after  waking  the  patient  felt  well,  possibly  as  a 
result  of  the  preventive  suggestion  of  well-being  which  was  never  omitted. 
He  declared,  indeed,  that  his  activity  and  his  ability  to  work  had  increased 
during  the  treatment.  The  suggestions  were  realized  almost  without 
exception  with  great  precision,  no  matter  whether  given  in  a  state  of 
somnolence  or  somnambulism.  Suggestive  treatment  was  directed  53^8- 
tematically  against  the  sexual  perversion.  First,  indifference  and  re- 
sistive power  in  regard  to  the  male  sex  were  suggested,  with  the  assur- 
ance that  the  patient's  interest  in  the  female  sex  would  continually 
increase.  Strictest  forbiddance  of  inclination  to  onanism.  Females  were 
substituted  for  males  in  dreams  at  night.  Even  after  a  few  sittings  the 
patient  said  he  found  pleasure  in  seeing  female  forms,  which  he  had  not 
known  before.  In  the  seventh  sitting  intercourse  with  a  female  was 
arranged  and  certain  success  suggested.  On  the  same  day,  January  29, 
1889,  the  patient  performed  successful  coitus  for  the  first  time  in  his  life. 
From  this  time  R.'s  sexual  congress  was  regulated  by  suggestion,  and 


236  SEXUAL    PAR^ESTHESIA. 

it  was  always  performed,  after  definite  intervals,  with  the  same  success. 
Fear  of  a  relapse  and  his  hereditary  predisposition  caused  me  to  con- 
tinue the  suggestions,. with  various  intervals,  for  some  time.  With  the 
help  of  suggestion  he  had  regained  his  mental  equilibrium ;  at  least,  he 
felt  himself  no  longer  dependent  on  men.  Nevertheless,  he  had  struggles 
when  the  pauses  between  sittings  were  long.  While  R.  continued  under 
the  educational  influence  of  suggestion  for  three  months,  and  he  was 
mentally  and  physically  in  full  possession  of  his  sexual  powers,  on  April 
22,  18,89,  a  relapse  was  caused  by  a  friend,  which  the  patient,  in  his 
open-heartedness,  confessed  to  me.  Energetic  opposing  ideas  given  in 
hypnosis  awakened  remorse  and  disgust.  But  to  test  his  stability  he 
performed  coitus  with  a  woman  in  the  presence  of  his  seducer,  and  imme- 
diately broke  off  his  association  with  him.  At  this  time  R.  confessed  to 
me  that  in  intercourse  with  women  of  inferior  education  his  aesthetic 
feelings  were  not  satisfied,  and  he  thought  to  find  this  only  in  a  happy 
marriage.  I  strengthened  this  thought,  and  after  a  few  weeks  I  received 
notice  that  he  was  engaged  to  a  young  lady. 

When  he  visited  me,  after  marriage,  R.  assured  me  that  the  happi- 
ness he  had  in  intercourse  with  his  bride  made  him  insensible  to  other 
impressions.  He  thought  himself  recovered,  and  up  to  the  present  time 
his  mental  equilibrium,  induced  by  suggestion,  which  has  endured  six 
months  (save  for  the  relapse  mentioned),  seems  to  be  retained. 

To  what  extent  psychical  treatment  has  been  successful, 
with  the  patient's  hereditary  predisposition,  in  repressing  or 
limiting;  the  tendency  to  abnormal  sexual  feelings,  can  only 
be  judged  after  years.  But  that,  by  the  systematic  application 
of  a  new  educating  influence,  a  temporary  complete  inner  change 
lasting  six  months  was  attained  seems,  with  reference  to  the 
powerlessness  of  other  methods  of  treatment  in  sexual  anoma- 
lies, like  a  step  in  advance  that  should  not  be  underestimated; 
and  that  the  more  since,  in  spite  of  the  relatively  large  number 
of  forty-five  hypnotic  sittings,  there  was  not  observed  any  in- 
jurious effect  on  a  single  occasion. 

And,  even  should  there  be  the  misfortune  of  a  relapse,  still 
a  repetition  of  the  procedure — hypnotic  suggestion — would 
remain  the  most  effectual  means  of  remedy. 

Soon  after  the  first  report  was  printed,  the  patient  wrote 
me  as  follows: — 

"  I  think  I  can  regard  myself  as  cured ;  for,  since  the  conclusion  of 
your  treatment,  my  condition  has  remained  essentially  unchanged.  If 


CONTRARY   SEXUAL   INSTINCT.  237 

reminiscences  of  my  previous  condition  often  come  up,  they  are  but  tran- 
sitory and  inner  events.  What  seems  to  me  the  decisive  point  is  that  the 
nervous  unrest,  in  which  I  was  completely  without  resistive  power,  as  if 
driven  by  an  inexplicable  impulse  to  gratify  my  former  inclinations,  seems, 
as  I  hope,  to  have  gone  forever.  In  constant  intercourse  with  one  uncom- 
monly attractive,  I  now  find  rest  and  happiness,  which  were  formerly 
impossible  for  me.  Be  assured  that  I  shall  never  forget  what  you  have 
done  for  me.  Gratefully,  R." 

At  Professor  von  Krafft-Ebing's  request,  in  January,  1890, 
eight  months  after  the  cessation  of  hypnotic  treatment,  I  asked 
for  another  detailed  report,  which  follows : — 

"  Through  the  suggestive  treatment  given  me  by  Baron  Schrenck, 
for  the  first  time  I  became  possessed  of  the  psychical  condition  that  per- 
mitted me  to  have  intercourse  with  a  woman,  which,  up  to  that  time,  in 
spite  of  repeated  efforts,  I  had  been  unable  to  do  successfully. 

"  Since  my  aesthetic  needs  were  unsatisfied  by  intercourse  with 
prostitutes,  I  thought  to  find  my  real  salvation  in  matrimony.  An 
earlier  friendly  inclination  toward  a  lady  known  in  my  youth  offered  me 
the  opportunity,  the  more  because  I  believed  that  she,  of  all  others, 
would  be  in  a  position  to  awaken  feelings  for  the  opposite  sex  which  were 
absolutely  foreign  to  me.  Her  character — i.e.,  our  harmony — is  in  such 
accord  with  my  inclinations  that  I  am  fully  convinced  that  I  shall  also 
find  complete  psychical  satisfaction.  This  conviction  has  not  changed 
during  the  eight  months  of  my  engagement. 

"  I  intend  to  be  married  in  about  eight  weeks,  and  I  shall  take  the 
liberty  to  give  a  report  of  the  further  results  soon  after  my  marriage. 

"  As  far  as  my  position  with  respect  to  my  own  sex  is  concerned, 
my  power  of  resistance — and  this  is  the  lasting  positive  result  of  this 
treatment — is  absolutely  changed  in  degree.  While  previously  it  was 
impossible  for  me  to  overcome  an  intense  sexual  excitation  when  I  saw 
a  finely-formed  car-driver,  to-day,  in  the  company  of  my  former  lovers,  I 
am  without  sexual  excitement.  At  the  same  time  I  must  add  that  now, 
as  formerly,  their  society  has  a  certain  attraction  for  me,  though  it  is  not 
to  be  compared  with  my  earlier  passion. 

"  On  the  other  hand,  I  have  refused  repeated  persuasions  to  indulge 
in  sexual  intercourse  with  men,  without  expending  much  force  in  resist- 
ance,— persuasion  I  should  have  been  unable  to  resist.  I  may  say,  in- 
deed, that  it  is  a  feeling  of  compassion  for  my  former  lovers,  who  have 
proved  their  devotion  to  me,  which  keeps  me  from  directly  repulsing 
them.  My  action  seems  to  be  due  to  a  feeling  of  duty  rather  than  to 
inner  need. 

"  Since  the  conclusion  of  treatment  I  have  not  consorted  with  pros- 


238  SEXUAL    PAILESTHESIA. 

titutes.  This  circumstance  and  the  numerous  letters  and  persuasions 
from  my  former  lover  may  well  be  the  reason  why,  in  the  eight  months 
that  have  elapsed,  I  have  allowed  him  to  persuade  me  to  sexual  inter- 
course on  three  or  four  occasions.  At  these  times  I  have  always  been 
conscious  of  being  completely  master  of  myself,  as  compared  with  earlier 
passionate  conditions  in  like  situations,  as  the  violent  reproaches  of  my 
friend  convinced  me.  I  always  feel  a  certain  unconquerable  repugnance, 
which  cannot  be  based  on  moral  grounds,  but  which,  I  believe,  must  be 
attributed  to  the  treatment.  I  no  longer  feel  a  love  for  him  in  the  former 
sense.  Besides,  since  the  treatment  I  have  sought  no  opportunities  for 
sexual  intercourse  with  men,  and  I  feel  no  need  of  it.  But  formerly  not 
a  day  passed  on  which  I  did  not  do  it,  so  that  at  times  I  was  unable  to 
think  of  anything  else.  Awake  or  dreaming,  ideas  of  sexual  content  are 
very  infrequent. 

"  I  may  express  the  belief  that  my  marriage,  which  is  .to  take 
place  in  a  few  weeks,  and  the  much-desired  change  of  circumstances 
connected  with  it,  will  entirely  remove  the  residuum  of  my  earlier  con- 
dition. I  conclude  these  lines  with  the  honest  assurance  that,  subject- 
ively, I  am  another  man,  and  that  this  change  has  restored  the  mental 
equilibrium  that  was  previously  wanting." 

Still  more  important  in  judging  the  question  is,  it  seems  to 
me,  the  patient's  letter  giving  a  report  of  his  wedding-journey. 
It  is  dated  March  20,  1890,  and  is  as  follows: — 

"  HONORED  SIR  :  Having  been  home  some  days  from  my  wedding- 
journey,  I  wish  to  send  you  a  short  report  of  my  present  condition. 
During  the  week  before  my  marriage  I  was  in  great  excitement,  because 
I  feared  that  I  should  be  unable  to  perform  certain  duties.  The  impel- 
ling thoughts  of  my  friend,  who  wished  another  meeting  with  me  at  any 
price,  had  no  effect  on  me.  We  have  not  met  since  I  saw  you  last  (in 
about  two  months).  However,  I  was  much  troubled  with  the  thought 
that  my  marriage  must  be  unhappy.  Now,  however,  I  have  no  anxiety. 
To  be  sure,  on  the  first  night  success  was  difficult  (to  induce  sexual  ex- 
citement in  myself) ;  but  on  the  following  night,  and  since,  the  influences 
needed  by  a  normal  man  would  have  been  sufficient  for  me.  I  am  con- 
vinced that  the  harmony  between  us,  which,  of  course,  is  mentally  of 
long  standing,  will  become  more  and  more  complete.  A  relapse  to  the 
former  condition  seems  impossible.  It  is,  perhaps,  significant  for  my 
present  condition  that  I  one  night  dreamed  of  my  former  lover,  and 
that  the  dream  was  not  sensual,  and  did  not  excite  me  sensually. 

"  I  am  satisfied  with  my  present  circumstances.  I  am,  of  course, 
well  aware  that  my  present  inclinations  are  far  from  being  of  a  degree 
that  equals  their  former  intensity.  I  believe,  however,  that  they  will 


CONTRARY   SEXUAL   INSTINCT.  239 

grow  stronger  daily.  Already  my  former  life  is  incomprehensible  to  me, 
and  I  cannot  understand  why  I  did  not  earlier  think  to  overcome  my 
abnormal  sexual  instinct  by  normal  sexual  indulgence.  A  relapse  would 
now  be  possible  only  with  an  entire  change  of  my  mental  life ;  and,  in  a 
word,  it  seems  impossible.  Your  obedient  servant,  R." 

The  external  circumstances,  the  patient's  changed  position 
in  life,  and  the  regular  hetero-sexual  relation  based  upon  actual 
sympathy  will  probably  assure  him  against  relapse  for  years, 
and  probably  control  the  rudiments  of  homo-sexual  feelings  still 
present.  In  contradiction  of  the  opinion  expressed  by  Professor 
Benedikt,1  the  foregoing  case  shows  that  "  pure  mental  hygienic 
self-exercise,"  "  simple  moral  treatment "  of  the  patient  in  the 
waking  state,  did  not  attain  the  desired  object;  and,  on  the 
other  hand,  that  the  result  obtained  only  by  means  of  hypnotic 
suggestion  neither  demoralized  the  patient  nor  induced  in  him 
"  the  destructive  consciousness  of  having  been  the  involuntary 
tool  of  the  physician's  art."  But  it  restored  the  absent  moral 
equilibrium  without  injurious  eifect,  which  is  to  be  hoped  will 
endure  for  years. 

Among  the  few  cases  of  contrary  sexual  instinct  that  have 
thus  far  been  treated  by  suggestion  and  reported,  there  is  none 
in  which,  with  respect  to  the  intensity  of  the  effect  and  the 
permanence  of  the  success,  a  similar  result  has  been  obtained  as 
favorable  as  that  reached  in  this  case. 

In  May  of  this  year  exactly  two  years  had  passed  since 
the  conclusion  of  treatment.  In  February,  1891,  R.  became  a 
happy  father.  There  can  be  no  doubt  that  the  further  conduct 
and  condition  of  the  patient  are  of  great  importance  in  forming 
a  judgment  of  suggestive  therapeutics  in  such  cases.  There- 
fore, I  addressed  him,  and  on  May  3,  1891,  exactly  two  years 
after  the  conclusion  of  treatment,  I  received  the  following 
letter : — 

"  HONORED  BARON  :  It  is  somewhat  difficult  for  me  to  be  perfectly 
clear  about  my  own  condition,  for  there  are  almost  always  slight  varia- 
tions ;  however,  in  what  follows,  I  hope  to  give  you  as  exact  a  description 
as  possible. 

1  Comp.  Internationale  klinische  Rundschau,  III  Jahrgang,  Nr.  40.  "  AUB  der 
Pariser  Congresszeit." 


240  SEXUAL    PAR^ESTHESIA. 

*'  You  will  first  ask,  probably,  whether  I  still  feel  the  effect  of  your 
treatment;  and  this  question  I  may  answer  decidedly  in  the  affirmative." 
A  short  time  ago  I  had  opportunity  to  test  my  resistive  power  with  my 
former  lover,  who  paid  me  a  visit.  During  hi£  stay  I  was  entirely  cold, 
and  refused  decidedly  to  meet  him  anywhere  in  the  evening.  Still,  this 
indifference  may  well  have  been  due  to  the  fact  that  I  no  longer  love  him. 
Whether  I  could  fall  in  love  with  any  one  else  I  cannot  say  with  cer- 
tainty ;  but,  at  any  rate,  I  make  no  attempts  to  approach  any  one,  and 
during  the  day  I  am  quite  free  from  all  such  ideas,  even  though  I  cannot 
den3'  that  now  and  then  soldiers,  and  others,  are  a  pleasing  sight  to  me ; 
and  I  well  know  that  no  approach  between  us  is  possible.  At  night 
quite  frequently  the  old  dreams  come,  and  fancies  of  the  nature  in  ques- 
tion put  me  to  sleep ;  but  I  always  feel  myself  master  of  the  situation, 
and  look  upon  this  unpleasant  memory  as  the  residuum  of  my  past, 
which  probably  will  never  be  entirely  extinguished.  I  also  believe  that 
my  original  natural  condition,  though  much  weakened,  will  remain  ;  but 
I  am  no  less  certain  that  a  relapse,  as  long  as  present  circumstances 
continue,  is  excluded. 

"  Now,  to  pass  to  the  opposite  side  of  my  sexual  feeling,  I  find  it 
very  peculiar  that  my  sensual  excitement  at  present  may  be  as  easily  in- 
duced by  the  female  as  by  the  male  sex,  only  with  this  difference, — that 
fancies  of  the  latter  come  spontaneously.  Too,  it  costs  me  no  effort  to 
transform  these  fancies  into  those  of  females,  while  formerly  I  noticed 
that  the  former  were  always  accompanied  by  horror  feminse,  which,  as 
you  know,  at  the  time  I  began  your  treatment,  was  constant  and 
unconquerable. 

"  I  also  notice  that  the  condition  described  has  been  thus  favorable 
only  since  September,  that  during  the  time  before  that  I  had  a  relapse, 
due  to  the  prolonged  absence  of  my  wife.  However,  at  that  time  I  was 
far  less  potent  than  formerly.  After  September  I  first  came  to  realize 
that  during  the  first  months  my  marriage  was  not  as  happy  as  it  should 
have  been  ;  at  that  time  spontaneous  sensual  excitement  with  the  female 
sex  was  wanting,  and  it  was  always  necessai'y  for  me  to  induce  it  arti- 
ficially. (During  the  time  of  your  treatment  this  was  not  necessary.) 
Naturally,  the  product  of  the  will  and  reflection  was  very  cold.  My  wife 
was  much  struck  by  the  change,  which  took  place  quite  rapidly.  To  her 
mother  she  said  :  '  Thank  heaven,  the  ice  is  broken!'  I  repeat  this  ex- 
pression because  it  seemed  very  characteristic ;  for  I  myself  felt  all  at 
once  as  if  an  obstacle  between  us  had  been  removed.  Since  that  time  my 
conduct  has  changed  very  much ;  before  I  was  merely  polite,  now  I  am 
like  a  lover  with  his  beloved.  That  the  old  fancies,  as  I  have  mentioned, 
still  occur  is  inexplicable  to  me  ;  but  you  will  understand  that,  at  least  in 
the  waking  state,  they  have  no  power  over  me,  for  I  am  always  able  to 
paralyze  them  with  their  opposites.  I  had  determined,  after  my  wife's 


CONTRARY    SEXUAL   INSTINCT.  241 

confinement,  to  abstain  from  congress  with  her,  but,  unfortunately,  I 
have  not  kept  my  resolution. 

"  I  often  study  the  question  as  to  what  I  should  do  if  my  wife 
were  to  die.  If  I  were  to  remain  a.  widower  I  think  I  should  return  to 
my  former  life,  though  it  would  be  necessary  for  me  to  accustom  myself 
to  it  again ;  still,  I  am  not  so  sure  of  the  last. 

"  Very  truly  yours, ." 

This  case,  so  instructive  in  its  bearings  upon  the  signifi- 
cance and  importance  of  suggestive  therapeutics,  leads  me  to 
make  the  following  remarks  in  review  of  it : — 

1.  As  a  result  of  the  influence  of  hypnotic  suggestion — at 
least,  during  the  two  years  that  have  passed — we  have  the  per- 
manent removal  of  (a)  horror  feminse ;  (6)  the  functional  in- 
capability of  the  erection-centre  to  hetero-sexual  charms  (due  to 
cerebral  influence) ;  (c)  the  sexual  hypersesthesia  in  relation  to 
the  same  sex  (irresistible  yielding  to  friends,  passionate  male- 
love,   erection   at   the  sight  of  powerful  men) ;   (c?)    onanistic 
inclinations. 

2.  Systematic  hetero-sexual  intercourse  in  marriage,  made 
possible  by  suggestion,  (a)  keeps  the  patient  from  real  relapse. 
Homo-sexual  intercourse,  which  occurred  twice  in  the  two  years, 
was   only  episodical   and   without  deep   psychological   motive 
(faute  de  mieux),  and  it  was  indulged  in  when  the  opportunity 
the  patient  desired  was  wanting,  as  during  the  prolonged  absence 
of  his  wife.     (Z>)  Preserves  in  him  the  inability  to  have  intense 
homo-sexual  feeling,  which  increases  with  time  (in  comparison 
with  his  former  susceptibility  to  it) ;  resthetic  satisfaction  and 
lustful  feeling  in  male-love  are  relatively  slight. 

3.  Remnants  of  the  natural  contrary  sexual  disposition  of 
the  patient  are  present,  and  manifest  themselves  (a)  in  dreams, 
in  considering  which  it  is  to  be  remembered  that  during  hyp- 
notic treatment  the  female  sex  was  also  the  subject  of  dreams ; 
(&)  in   the  interest  in  handsome  men  which   still    exists,  but 
which  is  not  accompanied  by  sexual  feelings.     Before  treatment 
this  interest  induced  erections,  but  not  after  treatment. 

4.  The   treatment, — i.e.,  the  hypnotic    suggestions,   com- 
bined  with    systematic    hetero-sexual   intercourse, — continued 

16 


242  SEXUAL    PAR^ESTHESIA. 

after  the  conclusion  of  the  sittings,  artificially  induced  (a)  a 
power  to  resist  male  temptation,  which  was  repeatedly  tried, 
and  complete  self-control,  which  kept  the  patient  from  conflict 
with  the  law ;  (6)  the  possibility  of  hetero-sexual  feeling,  of  the 
existence  of  which,  in  the  life  of  the  patient  before  the  treat- 
ment, there  were  no  indications;  (c)  the  need  of  hetero-sexual 
intercourse,  which  increased  with  time.  It  was  so  strong  that 
the  patient  was  unable  to  keep  his  resolutions  made,  presum- 
ably, on  account  of  the  puerperal  state. 

At  the  present  time  the  patient  is  in  the  condition  of  per- 
sons subject  to  acquired  contrary  sexual  instinct.  With  refer- 
ence to  his  natural  homo-sexual  disposition,  assuming  that  it  is 
really  such,  his  hetero-sexual  feelings  constitute  an  artificially 
cultivated  anomaly  of  habit,  similar,  for  example,  to  that  of 
smoking,  which,  as  a  cultivated  habit  opposed  to  the  natural 
reaction  (nausea,  vomiting,  foul  taste),  may  become  an  irresistible 
passion. 

As  a  rule,  patients  subject  to  acquired  contrary  sexual  in- 
stinct pass  through  the  stage  of  psychical  hermaphroditism ;  the 
cure  takes  place  through  a  reversal  of  the  same  process.  Thus, 
the  patient  is  excitable  to  both  sexes,  and  thus  fancies  about 
men  may  be  voluntarily  transformed  Avithout  opposition  into 
those  of  females,  and  with  the  same  physical  reflex  effect.  The 
addition  to  the  influences  affecting  the  patient  determine  the 
direction  of  further  sexual  development.  It  cannot  be  doubted 
that,  in  the  fortunate  matrimonial  relations  of  the  patient,  this 
development  will  be  of  an  hetero-sexual  nature.  These  cir- 
cumstances constitute  a  constant  stimulus  for  him,  which  has 
become  strong  enough  to  easily  paralyze  all  accidental  seductive 
tendencies.  The  stronger  the  feeling  for  the  female  sex  becomes, 
the  weaker  will  homo-sexual  feeling  grow.  At  the  present  time 
it  manifests  its  harmless  presence  only  episodically  and  in 
dreams.  But,  in  the  degree  in  which  hetero-sexual  intercourse 
results  in  aesthetic  and  physical  satisfaction,  the  desire  for  active 
sexual  satisfaction  will  be  enhanced.  The  reflex  effect  of  this 
phenomenon  must  gradually  manifest  itself  in  an  intensification 
of  the  general  feeling  and  inclinations  characteristic  of  a  man, 


CONTRARY   SEXUAL  INSTINCT.  243 

as  a  psychical  transformation  gradually  completing  itself  with 
the  course  of  time.  But  to  what  extent  the  individual's  mental 
change  can  go  depends,  in  our  case  as  in  all  others,  upon  the 
congenital  defect ;  upon  the  extent  of  the  anatomical  and  un- 
alterable degenerative  state, — if  there  be  really  such  a  condition 
present.  The  hetero-sexual  feelings  existed  but  two  years ;  and, 
in  contrast  with  this,  it  should  be  considered  that  the  homo- 
sexual manner  of  feeling  dominated  the  period  of  life  from  the 
age  of  18  to  28,  the  most  important  in  sexual  development,  and 
therefore  lasted  twelve  years.  Natura  nee  fecit  saltum.  There- 
fore the  patient's  recovery  must  always  be  in  proportion  to  the 
development  of  his  malady.  This  should  be  especially  empha- 
sized, owing  to  the  common  opinion  of  the  laity  that,  in  a  few 
hypnotic  sittings,  as  if  by  magic,  a  patient's  old  personality, 
with  its  inherent  diseases  and  defects,  can  be  eradicated. 

Nevertheless,  in  our  case,  should  there  arise  no  abnormal 
unfavorable  influence  of  an  opposite  nature,  it  is  to  be  expected 
that  the  patient's  psycho-sexual  development  in  relation  to  the 
female  sex,  resting  upon  the  foundation  of  the  last  two  years, 
will  progress  with  every  ensuing  year  and  become  fixed. 

In  this  sense,  thanks  to  the  help  of  hypnotic  suggestion, 
the  prognosis  and  treatment  of  the  congenital  form  of  contrary 
sexual  instinct  seem  less  unfavorable  than  heretofore.  Though 
Krapelin,  in  his  text-book  on  Psychiatry  (p.  576),  says,  "  There 
can  be  no  thought  of  treatment  of  this  anomaly,  which  has 
developed  with  the  development  of  the  character  and  has  its 
roots  deep  in  the  individuality,"  without  giving  his  opinion  any 
more  solid  foundation,  still,  the  logic  of  facts  which  have  already 
been  confirmed  by  the  experience  of  other  authors  speaks  a 
more  convincing  and  persuasive  language  than  that  of  mere 
theoretical  speculation.  In  congenital  contrary  sexual  instinct, 
if  such  a  form  actually  occur,  essential  improvement  and  even 
relative  cure  may  be  attained. 

Condition. — After  giving  the  foregoing  history  the  patient 
wrote  to  Professor  von  Krafft-Ebing  and  myself,  giving  some 
not  unimportant  additional  facts.  Thus,  in  the  performance 
of  marital  duties,  of  which  he  wrote  on  May  20,  1890,  the 


244  SEXUAL    PAILESTHESIA. 

patient  found  that,  as  he  recognized  eight  weeks  later,  he 
had  deceived  himself.  The  act  which  he  thought  to  be  that 
of  sexual  intercourse  was,  in  fact,  only  an  imitation,  namely, 
coitus  inter  femora  (practiced  in  homo-sexual  intercourse). 
For  this  act  it  was  necessary  at  times  (not  always)  to  induce 
erection  artificially  or  by  the  aid  of  contrary  sexual  ideas. 
After  the  error  was  recognized,  there  was  performance  of  actual 
coitus,  but  still  by  means  of  erection  artificially  induced.  After 
five  or  six  months,  on  an  occasion  when  his  wife  had  a  nervous 
attack,  there  was  sudden  and  unexpected  occurrence  of  spon- 
taneous hetero-sexual  feelings  and,  for  the  first  time,  completely 
satisfactory  coitus  quoad  erection  and  lustful  feeling.  At  the 
same  time  there  was  a  favorable  change  of  the  marital  relations. 
From  this  time  the  sexual  relations  became  the  expression  of 
an  irrepressible  tender  attachment,  and  they  took  place  without 
artificial  excitation  of  any  kind. 

Thus,  the  patient  attained,  though  not  in  exactly  the  way 
described  in  his  letter,  the  same  end.  Homo-sexual  rudiments 
manifest  themselves  now  and  then  in  dreams. 

This  concluding  description  only  speaks  for  the  truth  of 
the  history,  which,  owing  to  the  intense  suggestibility  of  the 
patient,  was  painted  in  too  favorable  colors. 

Case  63.  Personal  Observation.  Contrary  Sexual  Instinct,  with 
Complete  Effemination  (as  a  Symptom  of  Moral  Imbecility').  Successful 
Treatment  of  Homo-sexual  Feeling  in  One  Hundred  and  Forty-two  Sit- 
tings. Time  of  Observation,  One  Year  and  Eight  Months. — The  follow- 
ing letter  led  to  treatment  of  the  case  : — 

"Munich,  July  22,  1891.  Dear  Doctor:  After  having  conquered 
myself  and  brought  myself  to  visit  you,  I  was  compelled  to  leave  your 
office  on  learning  that  you  were  absent  from  town.  Therefore,  I  take 
the  liberty  to  write  you ;  for,  should  I  wait  for  your  return,  my  courage 
might  fail  me  to  report  verbally  what  I  can  write  much  more  easily.  To 
be  brief,  I  belong  to  those  miserable  and  unfortunate  persons  with  which 
von  Krafft-Ebing's  book  is  concerned ;  and  since  I  only  yesterday  ob- 
tained the  fifth  edition  of  that  work,  the  resolve  which  I  made  in  Janu- 
ary, after  your  lecture,  to  ask  you  for  help,  and  which,  from  shame  and 
weakness,  I  did  not  carry  out  at  that  time,  was  carried  out.  For  the 
case  there  described  of  an  urning  cured  gave  me  hope  that  your  art 
might  also  help  me. 


CONTRARY   SEXUAL   INSTINCT.  245 

"From  birth,  in  all  my  feelings  and  actions,  I  have  been  more  like 
a  female  than  a  male.  As  a  child  I  played  with  dolls,  and  never  liked  to 
play  with  soldiers ;  and  I  used  every  opportunity  to  dress  like  a  girl, 
and  I  still  do  this  successfully.  All  my  thought  is  directed  to  the  pos- 
session of  a  man  ;  I  am  inordinately  vain,  always  seeking  to  please,  and 
superficial,  and,  at  the  same  time, — what  the  error  of  nature  necessarily 
brings  with  it, — very  unhappy ;  for  I  never  conceal  from  myself  for  a 
moment  that  I  am  a  despised  creature,  and  that  my  inclination  is  low 
and  unnatural. 

"  A  complete  cure,  such  as  that  made  by  you,  and  described  by 
von  Krafft-Ebing,  I  do  not  think  possible  in  my  case ;  for,  were  you 
able  to  give  my  sexual  instinct  another  direction,  still  you  would  not 
make  a  man  of  me,  as  I  am  wanting  in  everything  characteristic  of  a 
man  :  courage,  decision,  energy,  perseverance  ;  and  I  desire  nothing  so 
much  as  to  be  subject  to  a  man,  to  love  him  and  serve  him.  Of  what 
use,  then,  would  such  an  effect  be  to  me?  I  desire  something  else.  Be- 
cause I  have  had  no  lover,  I  have  had  to  help  myself  with  onanism  ;  and 
it  is  this,  I  believe,  that  has  so  destroyed  my  nerves  that  I  am  not  far 
from  insanity.  For  the  headache  that  for  the  most  part  follows  onanism 
I  take  antipyrin  regularly,  1,  2,  or  3  grammes,  as  may  be  necessary; 
and  for  depression,  which  is  truly  frightful,  ether  and  valerian.  At  first 
these  medicines  helped  me,  giving  me  a  feeling  as  if  two  beings  were  in 
me  ;  for  I  became  joyous  and  excited,  and  had  palpitation ;  knowing, 
though,  that  I  had  really  no  reason  to  be  happy,  and  that  the  cause  of  my 
depression  was  not  removed  by  such  means.  Neither  is  any  longer  of 
assistance  tome;  for  the  despair  which  formerly  increased  to  violence 
has  given  place  to  apathetic  hopelessness  ;  and  I  know  that  my  way,  be 
it  short  or  long,  leads  to  suicide  by  drowning.  My  thoughts  follow  me 
in  dreams ;  and  often  I  wake  up  from  a  dream  covered  witli  sweat,  in 
which  I  stand  at  the  edge  of  a  dark  expanse  of  water  into  which  I  must 
go.  I  should  like  your  help  by  means  of  hypnotic  suggestion,  that  I 
may,  first,  cease  to  practice  onanism  ;  second,  that  I  may  cease  to  think 
constantly  of  men.  Formerly  I  occupied  myself  with  literary  work.  I 
have  published  two  comedies,  and  written  reviews  on  art,  historical 
essays,  etc.  But  all  that  is  over.  I  may  say  that  I  am  bankrupt  intel- 
lectually. Day  and  night  I  think  only  of  gratification  in  my  sense ;  I 
cannot  see  a  j'oung  man  without  the  painful  desire  to  possess  him.  I  do 
not  cross  the  street  or  enter  a  cafe  without  being  troubled  by  this 
desire.  And  yet  I  cannot  stay  at  home  ;  an  indefinite  feeling  of  anxiety 
drives  me  out.  Only  last  year  I  took  a  long  journe}- — Paris,  Cologne, 
Brussels,  Berlin,  Vienna — in  vain!  I  could  not  escape  from  my  sick 
and  weary  soul ;  I  took  the  poisoned  imagination  with  me  everywhere. 
Do  you  think  3rou  can  help  me  in  this  way;  that,  even  though  you  can- 
not cure  me,  you  can  make  me  better  ?.  When  you  return,  I  shall  take 


246  SEXUAL  PAR^STHESIA. 

the  liberty  to  call  on  you.     This  confession  will,  in  a  measure,  force  me; 
for  with  it  the  first  step  is  taken. 

"  Respectfully,  A." 

Autobiographical  Sketch  of  the  Patient. — "  Munich,  September, 
1890.  Dear  Doctor  :  On  my  first  visit  you  requested  me  to  write  my 
biography  for  you,  and  I  herewith  comply  with  your  wish.  I  was  boru 
in  1860,  in  H.,  the  son  of  a  respected  official  and  a  mother  descended 
from  an  old  family.  I  am  not,  I  think,  predisposed  hereditarily.  As  far 
as  I  know,  there  has  been  neither  physical  nor  mental  disease  either  in 
my  mother's  family — which  has  given  Bavaria  several  ministers,  diplo- 
mats, and  ambassadors — or  on  my  father's  side.  My  parents  are  healthy, 
as  are  my  sisters  ;  two  brothers  are  dead.  My  eldest  sister  (married) 
suffers  much  with  migraine.  Save  for  the  diseases  of  childhood — measles, 
scarlet  fever,  and  whooping-cough — I  have  always  been  healthy.  The 
fact  that  I  am  now  nervous,  and  have  been  so  for  years,  is  probably  due 
to  my  contrary  sexual  condition  and  onanism. 

"  From  youth  I  was  quiet,  avoided  all  noisy  boys'  play,  and  pre- 
ferred to  play  with  dolls.  I  was  hypersensitive,  easily  moved,  timorous 
(not  to  say  cowardly),  and  shy.  To  my  mother  I  clung,  and  I  do  still, 
with  the  tenderest,  almost  deifying,  love ;  while  I  feared  my  father  and 
lived  in  trembling  awe  of  him.  He  was  excessively  strict,  and  I  re- 
member seldom  to  have  had  a  kind  word  from  him.  If  he  were  in  a  good 
mood,  however,  he  liked  to  joke  and  tease  me  until  I  cried,  to  the  amuse- 
ment of  the  other  children,  relatives,  or  guests  who  might  be  present. 
He  did  this  for  years,  and  naturally  I  came  to  feel  that  I  was  a  ridiculous, 
strange  creature,  afflicted  with  peculiarities  which  made  me  the  butt  of 
ridicule  to  other  men.  Perhaps  my  melancholy  arose  from  this  early 
period  ;  for  I  know  that  as  a  child  I  was  pursued  by  a  sadness  which  no 
one  could  explain,  and  for  which  I  myself  could  have  given  no  good 
reason.  Nevertheless,  let  the  cause  of  it  be  what  it  may,  melancholy  has 
become  my  controlling  mood  ;  and  I  often  try  to  free  myself  of  it,  but  in 
vain.  Like  a  weight  of  lead  it  rests  on  me,  and  I  often  think  I  can 
endure  it  no  longer. 

"  At  5  I  entered  school  and  learned  easily ;  but  I  was  always  very 
lazy,  and  I  liked  to  read  for  my  amusement  rather  than  to  study.  Much 
reading  was  not  good  for  me;  it  overstimulated  my  imagination  by 
giving  my  mind  too  much  material,  and  at  last,  by  furnishing  me  with 
a  mass  of  the  most  varied  knowledge,  it  made  me  vain  of  my  learning. 
What  have  I  not  read?  I  was  scarcely  able  to  read  before  I  read,  at 
the  age  of  5,  my  first  storjr,  '  The  Two  Baronesses,'  by  Andersen  ;  and 
then  followed  novels,  poems,  etc.  At  9  I  knew  Frey tag's  '  Pictures  of 
Long  Ago  ';  at  12,  Lessing;  at  13,  Goethe;  and,  in  fact,  the  whole  of 
the  theory  of  color,  morphology,  and  all  the  rest.  I  read  everything, 


CONTRARY   SEXUAL    INSTINCT.  247 

without  discrimination.  I  preferred  only  one  thing, — Indian  stories. 
Historical  works,  like  Weber's  '  History  of  the  World,'  I  read  with 
great  delight,  repeatedly.  This  fever  for  reading,  which,  had  it  been 
directed  by  an  experienced  hand,  would  have  been  of  great  profit  to  me, 
perhaps,  abated  somewhat  when.  I  was  about  20.  Then  I  began  to  pro- 
ceed somewhat  systematically.  Now,  for  about  three  years,  I  have  as 
good  as  given  up  reading.  At  the  age  of  10  I  entered  the  cadet-corps. 
I  passed  the  examinations  without  difficulty,  and  in  some  things — for 
example,  German  and  histoi'y — I  was  always  the  best  scholar;  in  others, 
like  mathematics,  always  the  worst.  I  should  here  remark  that  I  have 
never  been  able  to  understand  higher  arithmetic ;  I  have  never  gone 
beyond  the  four  principles,  and  even  to  reckon  with  these  is  still  difficult 
for  me.  After  passing  through  all  the  classes  I  passed  my  examination, 
but  I  had  no  desire  to  be  a  soldier;  so  I  became  a  merchant,  and  am 
still.  Of  my  external  life  I  have  nothing  to  record,  except  some  jour- 
neys to  Italy,  Paris,  Vienna,  the  Rhine,  St.  Petersburg,  and  Denmark. 

"  Now  to  come  to  that  which,  for  you,  will  be  the  most  essential 
thing, — my  contrary  sexuality.  I  must  confess  that  I  have  never  felt 
anything  more  for  the  female  sex  than  respect,  friendship,  and  affection- 
ate regard  ;  never  warm  feelings.  I  early  felt  a  preference  for  feminine 
pursuits.  Till  my  fifteenth  year  I  loved  to  play  with  dolls,  and  when- 
ever I  could  I  dressed  like  a  girl.  In  questions  of  female  attire  I  am  a 
judge,  and  I  always  know  the  fashion  in  material,  color,  and  cut.  When 
in  the  cadet-corps,  I  soon  learned  that  my  boyish  attachments  were  more 
than  real  friendships, though  I  never  went  beyond  kissing  and  embracing; 
and  only  after  I  was  16  was  I  seduced  to  mutual  onanism  by  a  comrade, 
which  I  then  practiced  not  only  with  him,  but  with  several  others.  The 
real  sexual  relations  were  still  unknown  to  me,  and  in  solitary  onanism 
my  ideas  were  only  about  persons  of  the  male  sex,  for  my  experience 
had  afforded  me  no  other  objects.  When  I  left  the  academy  I  thought 
that  was  the  end  of  it  all ;  I  had  no  suspicion  how  many  fellow-sufferers 
I  had,  and  only  an  accident,  which  put  Ulrich's  writings  in  my  hands, 
opened  my  eyes  and  made  me  very  unhappy.  I  lived  in  very  pleasant 
surroundings,  but  without  association  with  persons  of  my  own  age,  and 
knew  not  how  to  obtain  such  friends  ;  and  thus,  in  my  eighteenth  year, 
I  began  to  indulge  in  onanism  in  earnest. 

"  Unfortunately,  I  had  opportunity  to  read  many  lascivious  books, 
and  I  can  boast  of  a  very  extensive  acquaintance  with  erotic  literature. 
Nothing  is  unknown  to  me,  from  the  tiresome  gossip  of  Casanova  to  the 
voluptuous  dilettanteism  of  '  Elegantise  Lat.  Sermones,'  the  Alcibiade 
fanciullo  a  scuola,  the  frivolous  sophistries  of  TheYese  philosphe,  and 
crazy  fancies  of  Marquis  de  Sade ;  and  my  memory  was  indelibly  im- 
pressed by  the  scenes  from  these  books,  till  my  imagination  was  poisoned 
and  busy  with  nothing  but  images  of  the  lowest  and  coarsest  sensuality. 


248  SEXUAL 

I  do  not  know  whether  I  possessed  a  trace  of  what  is  commonly  called 
morality  or  not ;  if  I  did,  I  lost  it  entirely.  I  longed  to  be  able  to  pros- 
titute myself,  to  be  violated ;  and  even  yet,  when  a  man  satisfies  himself 
with  me,  I  think  '  you  are  violated '  the  greatest  enjoyment.  My 
greatest  desire  has  alwaj's  been  to  be  violated  by  force. 

"  From  my  eighteenth  to  my  twenty-fourth  year  I  satisfied  myself 
only  in  onanism,  and  then  entered  into  a  relation — really  my  first — with 
a  man  somewhat  older,  who  satisfied  himself  with  me  in  coitus  in  anum. 
This  relation  lasted  four  months,  and,  though  we  were  much  attached  to 
each  other,  we  have  never  since  had  sexual  relations  with  each  other. 

"  I  then  moved  to  another  place,  where,  either  through  inex- 
perience, fear,  or  shyness,  it  was  a  long  time  before  I  made  the  acquaint- 
ance of  persons  like  myself;  but,  once  started,  I  became  acquainted 
with  many  immediately.  In  this  way  I  learned  all  manner  of  sexual 
indulgence  of  man  with  man.  The  men  who  gave  me  the  greatest 
pleasure  and  the  most  lustful  enjoyment  were  those  who  performed 
coitus  in  anum  with  me ;  and  when  the  man  was  handsome,  large, 
and  strongly  built,  he  caused  me  to  have  true  ecstasy  of  lust.  Only  one 
pleasure  was  wanting  to  me, — the  consciousness  of  being  able  to  bear  a 
child  to  the  loved  man ;  otherwise  I  was  truly  happy,  and  after  the  act 
felt  refreshed  and  strengthened  and  physically  and  mentally  at  ease. 
Though  this  manner  of  congress  has  been  performed  with  me  innumer- 
able times,  I  have  never  experienced  the  slightest  inconvenience  in  it, 
and  even  when  the  organ  inserted  has  been  of  unusual  size  I  have  felt 
no  pain.  The  pleasure  was  so  great  that  I  had  erection  and  ejaculation. 
The  latter  added  very  little  to  my  pleasure ;  so  that  I  often  held  myself 
back  that  I  might  be  ready  for  a  second  and  third  when  the  first  man 
had  finished.  It  was  like  a  kind  of  madness  for  men  that  came  over  me ; 
I  would  have — even  had  it  killed  me — given  mj'self  to  a  dozen. 

"  I  could  not  write  down  all  these  disgraceful  details  if  I  did  not 
think,  Doctor,  that  perhaps  you  will  regard  them  of  essential  importance 
for  my  treatment ;  besides,  I  hope  that  in  me  you  look  at  a  '  case,'  and 
not  at  a  man. 

,  "  My  greatest  desire, — at  least,  since  I  have  become  conscious  of 
my  condition, — the  only  object  of  my  striving,  has  been  to  be  loved,  to 
find  the  love  of  a  man.  I  have  never  found  it ;  and  yet  I  know  that  I 
could  have  sacrificed  all  to  such  a  person — all.  No  sacrifice  would  have 
been  too  great  for  such  love ;  all  that  I  possessed — honor  and  good  name 
and  even  my  family — I  would  have  given  up,  and  never  have  asked 
whether  the  man  were  old  or  young,  handsome  or  ugly,  low  or  high ! 
Sexuality,  little  as  that  was  to  be  ignored  in  the  matter,  could  not  have 
been  the  most  important  matter,  truly  not;  but  mental  union,  inner 
attachment,  actual  love, — not  a  passing  fancy,  which  I  also  prized  in  its 
way, — could  have  enchained  me.  It  was  never  mine ;  and  this  eternal, 


CONTRARY  SEXUAL  INSTINCT.  249 

unsatisfied  longing,  which  has  grown  more  intense  with  continuance, 
makes  me  so  miserable  that  I  forget  everything  but  this  desire ;  it  ban- 
ishes and  destroys  all  mental  interest,  and  all  seems  vain,  empty,  and 
unprofitable.  Like  a  fixed  idea,  the  thought  of  love — always  only  of 
love — pursues  me !  I  have  become  bitter  and  acrimonious,  my  dispo- 
sition gloomy,  and  as  with  closed  eyes  I  have  gone  through  a  world 
which  could  give  me  but  one  thing, — the  hope  of  death.  Suicide  came 
before  me  in  all  forms,  first  as  a  play  of  fancy,  then  more  and  more  dis- 
tinct and  threatening ;  awake  and  sleeping,  the  thought  pursued  me.  I 
was  forced  to  think  of  it ;  I  fought  painfully  against  it.  In  vain  1  The 
fear  of  becoming  insane  made  voluntary  death  enticing ;  showed  it  the 
lesser  of  two  evils. 

"What  have  I  not  done  to  help  myself?  To  benumb  myself,  I 
flew  from  onevpleasure  to  another;  I  sought  society,  and  then  fled  from 
it !  I  felt  that  my  descent  grew  faster  and  faster.  I  could  even  calcu- 
late how  long  it  would  last.  Then  I  read  in  von  Kraff't-Ebing's  '  Psy- 
chopathia '  the  cure  effected  by  you,  and  I  thought:  I  will  try  it;  it 
cannot  be  worse,  it  can  only  be  better.  I  confess  that  my  hope  was 
small ;  for  even  if  it  were  possible  to  give  ray  sexual  impulse  another 
direction,  would  I  then  become  a  '  man  '?  I  possess  no  will  at  all,  not  a 
trace  of  energy  ;  on  the  slightest  feeling  of  distaste,  I  throw  up  any 
undertaking.  I  wait  to  be  influenced  ;  I  have  no  character,  but  in  judg- 
ment and  opinion,  manner  and  speech,  etc.,  involuntarily  I  accommodate 
myself  to  my  surroundings.  I  cannot  refuse  a  request,  but  no  activity 
is  to  be  expected  of  me.  In  short,  Doctor,  if  you  can  make  a  man  out 
of  this  limp  rag,  then  your  art  can  do  wonders.  If  you  cannot,  then  no 
harm  will  be  done.  I  am  of  use  to  no  one,  but  the  greatest  burden 
to  myself,  and  perhaps  it  were  then  better  ended  1 

"  Herewith  I  submit  the  history  you  desired,  and  in  explanation  of 
it  I  may  note  that  in  female  attire  I  feel  much  better,  more  at  my  ease, 
than  in  my  own.  My  gait  and  my  manner  are  such  that  they  would 
never  convey  the  slightest  suspicion  of  my  sex  ;  and  to  such  attire  I 
am  indebted  for  the  happiest  hours  of  dancing,  conversing,  and  flirting 
with  my  own  sex ;  but  with  real  men,  not  with  '  aunts.' 

"  Very  respectfully,  A." 

Supplement  to  the  Patient's  Development  of  Homo-sexuality  and 
Character. — The  foregoing  autobiographical  notes,  in  content  and  form, 
give  a  fair  picture  of  Mr.  A.'s  condition,  and,  in  fact,  in  more  detail  and 
with  more  truth  than  would  be  possible  to  the  physician's  pen.  There 
is  but  little  to  add. 

I  began  to  treat  the  patient,  August  30,  1890.  Aged  30.  One 
brother  is  said  to  have  died  of  cerebral  softening  at  the  age  of  1  year; 
otherwise  the  history  of  the  family  presents  nothing  worthy  of  note. 


250  SEXUAL    PAILESTHESIA. 

Aside  from  the  diseases  of  childhood  and  a  very  intense  neuropathic 
constitution,  existing  since  earty  youth,  A.'s  physical  development  pro- 
gressed without  interruption.  Last  year,  gonorrhoea  from  contact  with  a 
male.  In  the  patient's  history  there  were  not  the  slightest  evidences  of 
hetero-sexual  inclination.  On  the  other  hand,  A.  states  that  in  earliest 
youth  he  manifested  a  great  disinclination  for  all  kinds  of  masculine 
employment  and  a  preference  for  household  work,  doll-play,  feminine 
dress,  etc. 

The  external  cause  of  the  complete  development  of  the  homo-sexual 
disposition  was  excessive  onanism,  practiced  in  the  cadet-corps, — that 
hot-house  of  the  most  dangerous  of  sexual  errors.  His  feminine  man- 
ner gave  him  the  nickname  of"  Lizzie  "  among  his  companions.  During 
the  time  of  puberty  all  external  circumstances  contributed  to  fully 
develop  A.'s  homo-sexual  impulse. 

For  women  he  had  never  had  anything  more  than  friendly  feeling. 
When  he  sought  their  society,  it  was  principally  to  get  advice  in  ques- 
tions of  dress.  Owing  to  his  libido  nimia,  gradual  development  of 
sexual  hypersesthesia  and  neurasthenic  symptoms.  As  we  see  from  his 
own  statement,  A.  practiced  all  the  acts  of  male  intercourse,  in  which 
the  detailed  performance  of  the  female  role  and  the  consciousness  of 
giving  a  man  lustful  feeling  gave  him  relatively  greater  satisfaction  than 
the  mere  physical  act. 

He  never  had  desire  for  the  active  role  in  the  sexual  act.  At  the 
age  of  24,  at  a  time  when  contrary  sexualit}'  had  attained  full  develop- 
ment, for  the  first  time  in  his  life  the  patient  accompanied  his  beloved 
friend,  a  man  of  masculine  feeling  who  found  no  pleasure  in  homo-sexual 
manipulations,  to  a  prostitute,  led  by  the  secret  desire  to  have  an  oppor- 
tunity to  see  naked  the  man  he  loved.  Greatly  excited  by  the  sight  he 
desired,  and  forced  to  content  himself  with  a  substitute,  he  performed 
coitus  with  a  prostitute,  never  for  a  moment,  however,  losing  sight  of 
the  object  of  his  desire.  After  that  he  made  two  more  trials,  which 
failed  on  account  of  intense  disgust  and  repugnance,  notwithstanding 
the  presence  of  the  man  he  loved.  Since  then  he  has  had  no  sexual 
contact  with  women. 

His  great  libido  goes  to  the  extent  of  madness  for  men ;  he  gives 
himself  to  men  without  choice,  but  feels  disgust  for  persons  of  his  own 
sex  like  himself.  The  patient's  imagination  is  abnormally  excited  by 
obscene  reading  and  unrestrained  dissipation.  Thus,  finally,  all  his 
thought,  feeling,  and  desire  are  directed  to  the  sexual  sphere.  His 
sexual  desire,  intensified  to  the  degree  of  satyriasis,  leads  him  to  all 
possible  perversities  of  the  sexual  act  (for  example,  pederasty  with 
several  persons  in  succession,  etc.),  and  makes  him  a  male  prostitute. 
His  sleep  is  disturbed,  and  for  years  has  been  interrupted  by  lascivious 
dreams  of  homo-sexual  content.  Before  falling  asleep  and  on  awaking 


CONTRARY   SEXUAL   INSTINCT.  251 

(from  dreams  and  in  the  morning)  there  are  always  erections  (stated  to  be 
for  years),  which,  owing  to  their  frequency,  are  annoying  and  sometimes 
painful,  and  which  always  lead  to  a  resumption  of  ominism.  Masturba- 
tion, as  a  rule,  mornings,  while  A.  in  a  doze  .gives  himself  up  to  fancies 
about  voluptuous  men  ;  sometimes  during  the  day.  As  a  rule,  aside 
from  homo-sexual  intercourse,  A.  masturbates  three  times  a  week ;  but 
he  has  practiced  it  daily  for  the  last  fourteen  days.  The  sight  of  male 
genitals,  in  pictures  and  on  statues,  induces  erection,  while  the  sight  of 
the  female  form  makes  no  impression  on  him.  The  patient  once  at- 
tempted to  engage  in  gymnastic  exercise,  but  had  to  desist  owing  to 
continuous  excitement  of  his  libido  sexuulis. 

But  not  only  is  A.'s  sexual  feeling  completel}'  developed  in  an  homo- 
sexual direction,  but  also  his  whole  mind.  Character,  feeling,  and  in- 
clinations, it  is  stated,  have,  since  earliest  youth,  developed  in  a  feminine 
direction.  Effemination  is  complete,  as  we  have  already  seen  from  the 
principal  points  of  the  autobiography.  A.  has  always  been  disinclined 
to  all  male  employment,  and  has  been  opposed  to  smoking,  drinking, 
and  sports. 

Dramatic  representation  of  the  female  role  gives  him  the  greatest 
pleasure.  His  knowledge  in  matters  of  female  attire  is  remarkable.  He 
possesses  several  feminine  toilettes,  and  he  loses  no  opportunity  to  wear 
them  temporarily  as  masks.  For  many  years,  in  the  winter  he  has  visited 
masked  balls,  etc.,  attired  as  a  woman.  In  speech,  movement,  gait, 
dance,  and  attitude,  as  well  as  in  the  whole  repertory  of  feminine 
thought,  as  expressed  in  conversation,  he  carried  out  so  perfectly  the 
movements  of  expression  and  the  arts  of  attraction  that,  in  his  mask, 
his  real  sex  was  never  suspected. 

He  repeatedly  had  himself  photographed  in  such  attire.  Two 
photographs  lie  before  me ;  one  represents  him  in  a  ball-gown  with 
flowers ;  the  other  in  a  costume  used  by  a  celebrated  prima-donna  in  one 
of  her  principal  roles.  None  of  the  numerous  persons  to  whom  the 
pictures  were  submitted  as  a  test  recognized  a  man  in  them.  Great 
preference  for  ostentation,  the  theatre,  belles-lettres  (successful  as  a 
writer),  especially  for  all  formality  and  appearance.  His  room  is  pro- 
vided with  feminine  toilet-articles ;  pictures  of  historical  urnings  orna- 
ment the  walls. 

In  comparison  with  the  understanding,  his  emotionality  is  strongly 
developed.  Great  softness  of  disposition.  Earnest  advice  by  me  con- 
cerning his  condition  moved  him  to  tears.  Whimsical,  irritable,  appre- 
hensive ;  devoid  of  self-confidence.  Patient  is  vain.  Conversation  in 
general  superficial.  Narrow  intellectual  horizon.  Logic  only  subjective, 
and  in  accord  with  the  feeling  of  the  moment.  Capable  of  self-sacrifice 
in  relation  to  real  male  love.  Enthusiastic  in  his  inclinations.  Sanguine 
temperament.  His  glance  betrays  coquetry,  lustfulness,  and  shyness. 


252  SEXUAL    PARJESTHESIA. 

Much  depressed,  owing  to  his  neuropathic  disposition  and  sexual  ex- 
cesses. Thoughts  of  suicide,'which  the  patient  has  never  carried  out 
because  of  cowardice.  Poor  self-control.  Weak  morally  ;  defective, 
sometimes  blind,  in  relation  to  his  perverse  actions,  and  incapable  of 
rational  thought.  Emotion,  like  the  instinctive  impulses,  sometimes 
attains  pathological  intensity.  On  the  whole,  great  weakness  of  char- 
acter. Incapable  of  forming  ethical  ideas ;  complete  lack  of  resistive 
power  to  external  impressions. 

A.  is  led  to  consult  a  physician  only  by  his  physical  complaints  of 
a  neurasthenic  nature,  due  to  his  sexual  excesses,  and  by  his  unsatisfied 
longing  for  a  lover,  which  gives  him  hours  of  bitter  despair.  Since 
coming  to  a  full  understanding  of  his  condition,  he  has  lost  interest  in 
everything,  even  in  the  most  important  questions  of  life,  in  as  far  as  they 
have  no  relation  to  his  feminine  tendency.  He  fulfills  his  business  duties 
mechanically  and  without  pleasure.  Writing,  which  formerly  gave  him 
complete  satisfaction,  he  has  since  then  entirely  abandoned.  Too,  in 
artistic  mutters  he  now  prefers  that  which  is  superficial  and  easy.  He 
is  an  assiduous  visitor  qf  varieties  and  operettas,  while  he  seldom  makes 
his  appearance  at  the  theatre  and  opera ;  at  most,  he  might  attend  a 
comedy.  In  this  direction  all  his  interest  is  in  men  in  female  parts. 

Besides  the  depression  mentioned  (tsedium  vitae),  the  patient  often 
suffers  with  migraine.  Sleep  is  restless,  interrupted  ;  attacks  of  anxiety, 
especially  when  he  is  alone.  Therefore,  he  avoids  solitude,  and  seeks  to 
divert  himself  with  amusements.  Lack  of  desire  for,  and  inability  in, 
mental  work.  General  listlessness,  especially  mornings.  Spinal  irrita- 
tion and  tachycardia. 

Present  Condition. — Of  medium  size ;  well  nourished  ;  of  delicate 
build.  Abundance  of  superficial  adipose  tissue.  Cranium,  on  the 
whole,  of  masculine  type ;  nowhere  sensitive  to  pressure.  Lobules  of 
ears  attached.  Growth  of  hair  not  remarkably  abundant. 

CRANIAL   MEASUREMENTS. 

1.  Horizontal  circumference,        .         .         .....  60  cm. 

2.  Posterior  half-circumference,   .         .         .        .         .  24  cm. 

3.  Anterior  half-circumference,    .         .         .         .         .  32cm. 

4.  Line  over  vertex  from  ear  to  ear,             .        .         .  39cm. 

5.  Antero-posterior  line  over  vertex,  .         .         .         .28  cm. 

6.  Ear-chin  line, 30  cm. 

7.  Long  diameter, .  20  cm. 

8.  Greatest  lateral  diameter, 16  cm. 

9.  Diameter  at  auditory  meati, 13  cm. 

10.  Diameter  at  zygomatic  process  of  frontal  bone,      .     12  cm. 

11.  Distance  from  auditory  me:itus  to  nasal  spine,         .     12cm. 

The  hair  blonde,  well   cared   for ;    the   moustache    from  time  to  time 


CONTRARY   SEXUAL   INSTINCT.  253 

shaved.  Eyes  have  a  neuropathic,  swimming  expression.  Patient  is 
myopic  and  wears  e3'e-glasses.  Pupils  dilated,  normal  in  reaction. 
Face  handsome,  approaching  the  female  type  in  form.  Expression 
sympathetic.  Face  pale,  and  looks  as  though  paint  and  powder  were 
habitually  used,  which  A.  confesses.  Skin  well  cared  for,  delicate  and 
white.  Breasts  very  well  developed  ;  breast  without  hair ;  hands  not 
feminine.1 

PELVIC   MEASUREMENTS. 

Female. 

Diameter  at  anterior  superior  spines,      .       25  cm.  26  cm. 

Diameter  at  crests  of  ilii,        .         .         .27  cm.  28-29  cm. 

Diameter  at  tubera  ischii,         .         .         .     8-9  cm.  10  cm. 

Diameter  at  trochanters,          „     _   .-        .       30  cm.  31  cm. 

Diameter — external  conjugate,         .         .       18  cm.  20  cm. 

Convergent  position  of  thighs.  The  genitals  of  medium  size  and  well 
developed.  Mons  veneris  with  abundant  hair.  Prepuce  can  be  easily 
retracted.  Voice  feminine  and  high.  On  the  whole,  the  form  is  well 
rounded  and  soft.  Attire  veiy  elegant,  almost  foppish  ;  odoriferous 
with  perfume.  Gait  mincing,  tripping.  Movements  graceful ;  gestures 
feminine.  In  his  general  appearance  there  is  something  elegant  and 
unmanly. 

Besides  the  active  stimulation  of  his  instinct,  the  patient  has  a 
demonstrable  want  of  moral  understanding,  and  incapability  of  forming 
moral  ideas ;  so  that  the  existence  of  a  moderate  degree  of  weak-minded- 
ness may  be  assumed. 

The  Treatment. — In  this  case  of  moral  insanity,  or  psychopathic 
subsidiary  defect  (anatomical  signs  of  degeneracy,  want  of  moral  sense, 
and  complete  effemination),  the  treatment  seemed  to  me  to  be  rendered 
especially  difficult.  Therefore  I  was  able  to  predict  only  the  probability 
of  decided  improvement,  while  complete  psycho-sexual  transformation 
was  scarcely  to  be  expected. 

The  objects  to  be  attained  by  treating  A.  could  only  be  the  follow- 
ing :  (a)  Thorough  removal  of  the  onanistic  inclinations  and  the  conse- 
quent physical  troubles.  (6)  Artificial  limitation  of  the  homo-sexual 
feeling  to  the  extent  of  complete  power  of  resistance  (indifference)  to 
male  charms,  (c)  Establishment  of  permanent  regular  hetero-sexual 
intercourse  for  the  satisfaction  of  sexual  desire. 

The  removal  of  physical  ailments  completed  the  treatment.  Only 
after  fulfillment  of  these  conditions  could  there  be  any  thought  of  a  psy- 
chical transformation  of  the  manner  of  feeling  in  an  hetero-sexual  sense, 
with  the  consequent  reflex  effect  upon  the  patient's  character.  The  limit 
of  possible  development  is  here  also  drawn  anatomically,  owing  to  the 
defective  organization  of  the  highest  psychical  centres  and  the  fixitjr  of 
1  Comp.  p.  263,  conclusion  of  letter. 


254  SEXUAL    PAR^STHESIA. 

existing  associations  in  the  apparatus  of  ganglion-cells  which  cannot 
be  influenced. 

The  great  importance  of  psychical  therapeutics,  of  moral  treat- 
ment, of  methodical  discipline  of  the  feelings  in  the  waking  state,  in  the 
entire  treatment,  is  not  to  be  undervalued.  The  physician  using  hyp- 
notic treatment  often  cannot  dispense  with  its  effects.  But  it  seems  very 
questionable  whether  the  application  of  such  means  will  be  sufficient. 
Hypnotic  suggestion  seems  to  us  as  the  foundation,  as  the  starting-point, 
of  therapeutic  procedure.  At  any  rate,  it  quickly  attains  the  object 
sought;  and,  by  removing  associated  and  contrasted  ideas,  it  more 
effectually  influences  the  mechanism  of  the  brain  than  do  psychological 
processes  in  the  waking  state.  But  both  forms  of  psychical  treatment 
seek  to  attain  the  same  end.  By  developing  fixed  and  permanent  asso- 
ciations (auto-suggestions)  they  seek  to  restore  to  the  patient  his  lost 
self-cultivation  and  to  give  him  control  of  his  nervous  mechanism ;  or 
to  establish  them  anew.  An  example  given  by  von  Krafft-Ebing  shows 
that  milder  forms  of  the  anomaly  can  sometimes  be  successfully  treated 
by  self-education.  But  he  regards  such  cases  as  infrequent  exceptions, 
and  he  cites  but  one  case.  Von  Krafft-Ebing  regards  hypnosis  as  the 
only  means  of  cure.  Therefore,  logical  correction  by  reason  and  sug- 
gestive command  must  be  completed  by  the  hypnotic  state  in  order  to 
put  the  patient  on  the  way  to  improvement. 

The  treatment  of  our  patient,  with  which  many  difficulties  were 
associated,  was  directed  in  accordance  with  these  principles. 

September  1,  1890.  First  attempt  at  hypnosis  (method  of  Nancy). 
Complete  hypotnxis  ;  suggestive  catalepsy  ;  somnolence.  Suggestions  : 
Disappearance  of  troublesome  erections,  which  disturb  sleep;  disappear- 
ance of  onanistic  inclinations  and  depression,  pleasure  in  business,  and 
physical  well-being.  After  awaking,  no  amnesia,  but  feeling  well. 

September  2d.  For  the  first  time  in  years  the  patient  went  to  sleep 
without  erections.  In  better  spirits.  Still  he  masturbated.  Hypnosis 
and  suggestions  as  yesterday. 

September  3d.  Patient  went  to  sleep  and  awoke  without  erections. 
He  felt  no  inclination  to  masturbate,  and  does  it  no  more.  He  awoke 
twice  with  annoying  erections.  Feeling  better  physically.  To  the 
suggestions  of  September  1st  interest  in  the  female  sex  is  added. 

September  4th.  No  more  onanism  ;  no  erections  on  falling  asleep 
or  on  awaking  ;  sleep  disturbed  once  by  erection.  Yesterday  A.  noticed 
the  actresses  at  the  theatre.  He  is  more  quiet  in  mind.  Suggestions  as 
on  1st  and  3d  of  September.  There  is  no  amnesia  to-day,  nor  in  later 
sittings. 

September  5th.  For  the  first  time  A.  awoke  in  the  night  without 
erection,  but  he  had  one  on  waking  in  the  morning.  A.  fights  strenu- 
ously against  his  inclination  to  onanism  without  yielding  to  it.  Sugges- 


CONTRARY   SEXUAL   INSTINCT.  255 

tions  as  on  the  1st  and  3d  of  September;  besides,  sexual  intercourse 
with  a  prostitute  to-day  is  energetically  suggested,  and  perfect  success 
promised. 

September  7th.  On  the  evening  of  September  5th  the  patient  reluct- 
antly visited  a  prostitute.  Erection  only  after  prolonged  manipulation. 
Coitus  performed  with  inner  repugnance.  Intense  physical  reaction  in 
an  attack  of  migraine  following  the  act.  Great  depression ;  suicidal 
thoughts.  On  the  evening  of  September  6th  and  the  morning  of  Sep- 
tember 7th,  masturbation. 

To-day,  removal  of  the  physical  complaints  by  suggestion.  No  more 
erections,  indifference  to  men,  as  well  as  the  suggestions  of  September 
1st  and  3d.  After  awaking  from  the  hypnosis,  is  like  one  transformed  ; 
no  bad  feelings  ;  hope  and  confidence. 

September  8th.  For  the  first  time  entire  absence  of  annoying  erec- 
tions on  going  to  sleep,  during  the  night,  and  on  awaking.  To  his  aston- 
ishment, A.  notices  a  kind  of  curious  interest  in  young  girls  (at  the 
theatre,  in  the  streets,  etc.).  He  still  has  lascivious  fancies  while  dozing 
mornings.  Struggle  against  onanistic  desires,  but  he  yields  and  mastur- 
bates. Again,  energetic  opposing  suggestions  with  the  usual  procedure. 

September  9th  to  13th.  Daily  hypnosis.  On  the  whole,  gradual 
progress.  Onanistic  inclinations  less  frequent ;  erections  gradually 
cease  to  occur.  Mental  improvement,  but  still  homo  sexual  'fancies. 
Once  more  coitus  on  September  14th,  again  giving  rise  to  unfavorable 
mental  and  physical  symptoms.  During  the  last  half  of  September,  in 
spite  of  my  advice,  A.  visited  me  but  very  irregularly,  and  several  times 
he  presented  himself  in  a  state  of  great  depression.  On  September  21st, 
third  coitus  with  somewhat  better  results.  States  that  he  has  interest 
in  a  young  woman.  His  feeling  is  very  variable. 

September  25th.  Violent  migraine  successfully  overcome  by  sug- 
gestion. From  the  end  of  September  to  the  10th  of  October  the  patient 
ceases  to  attend,  without  any  reason.  His  unusual  conduct  leads  me 
to  write  an  inquiry  concerning  his  condition,  to  which  I  received  the 
following  answer : — 

"  Munich,  October  10,  1890.  Dear  Doctor:  Pardon  me  if  I  answer 
your  inquiry,  which  I  have  but  now  received,  by  letter  rather  than  by 
word  of  mouth,  for  I  have  not  the  courage  to  tell  you  personally  what  I 
can  no  longer  conceal  from  you. 

"  Until  Sunday,  September  14th,  all  went  in  accordance  with  my 
desire,  slowly  but  steadily ;  the  suggestions  were  carried  out  with  the 
greatest  precision  ;  onanism,  with  all  its  accompanying  symptoms,  dis- 
appeared, and  I  hoped  confidently  for  improvement,  if  not  recovery. 
Then  came  that  unlucky  Sunday,  on  which,  at  your  desire,  I  wrote  my 
autobiography  ;  and,  in  coming  to  a  complete  understanding  of  my  con- 
dition, I  said  to  myself,  'You  cannot  be  cured;  it  is  not  your  sexual 


256  SEXUAL    PARJESTHESIA. 

desire  for  your  own  sex  that  predisposes  you,  but  your  mental  desire.' 
Then  I  gave  you  my  autobiography,  in  which  I  spoke  of  myself  never  so 
frankly,  even  to  my  confessor.  My  conviction,  reached  in  the  biography, 
as  well  as  your  statements,  robbed  me  of  courage.  I  lost  all  hope  of 
cure.  Terribly  humiliating  as  the  confession  is  to  me,  I  can  no  longer 
remain  silent.  Since  the  17th  of  September  I  have  practiced  my  old 
vice  daily.  I  have  three  times  been  with  men  ;  up  to  to-day  have  been 
with  women  but  three  times.  A  verbal  confession  would  be  too  painful 
to  me ;  hence  this  letter.  I  know  all  that  you  might  say  to  me ;  I 
realize  how  bad  my  conduct  is.  Thus,  since  that  day  the  treatment 
has  been  without  effect.  Perhaps  this  result  was  in  part  due  to  the  fact 
that  from  Forel  I  learned  how  much  of  its  effect  was  due  to  auto-sugges- 
tion,— real  imagination, — and  I  no  longer  had  faith  in  it.  Since  that  day 
all  is  as  it  was. 

"  I  do  not  venture  to  make  excuses,  for  I  am  well  aware  of  the 
despicableness  of  my  conduct.  The  fear  of  an  immediate  verbal  con- 
fession outweighed  all  else. 

"  Please  pardon  me  and  give  me  up.  After  this  confession  I  could 
not  look  you  in  the  face  again.  I  am  greatly  indebted  to  you,  dear 
Doctor.  How  much  pains  you  have  taken  with  me  !  But  you  are  not  to 
blame  that  what  you  said  with  the  best  intention  has  not  had  the  desired 
effect  on  me.  Pardon  me ! 

"  With  feelings  of  genuine  gratitude  and  of  greatest  respect, 

"Sincerely,  A." 

October  llth.  At  my  request  the  patient  came  again.  More  care- 
ful inquiry  shows  that  even  during  the  period  of  relapse,  and  in  spite  of 
his  despair,  A.  was  (a)  free  from  erections  at  night;  (6)  was  relatively 
better  (fancies  and  masturbation  infrequent)  ;  (c)  and  in  male  intercourse 
he  did  not  find  a  satisfaction  that  could  be  compared  with  former  similar 
feelings.  On  the  contrary,  his  expectations  were  not  fulfilled.  After  the 
act  he  felt  a  certain  repugnance,  a  kind  of  moral  regret. 

I  reassured  A.,  diverted  his  thoughts,  and  removed  his  misappre- 
hension, and  he  showed  himself  the  more  amenable  to  suggestions. 

From  this  time  till  the  end  of  the  month  he  was  hypnotized.  The 
sensitiveness  to  suggestion  increases ;  post-hypnotic  commands  are  per- 
formed with  precision,  but  there  is  never  amnesia.  General  faradization 
used  for  his  neurasthenic  symptoms  with  good  success. 

As  in  September,  the  suggestions  are  directed  to  masturbatic  in- 
clinations and  erections  ;  to  attempts  at  successful  coitus,  with  pleasure 
in  it,  and  inclination  for  the  female  sex  ;  and  to  physical  well-being.  Be- 
sides, greater  pleasure  in  work  and  resumption  of  writing  are  suggested. 

From  October  llth  to  14th,  good  success.  Unfortunately,  on  the 
latter  date  a  new  obstacle  to  the  patient's  progress  arose  in  the  form  of 
gonorrhcea,  which  the  p.atient  acquired  in  coitus.  It  was  cured  by  injec- 


CONTRARY   SEXUAL   INSTINCT.  257 

tions  by  the  end  of  October.  Still,  this  month  was  one  of  considerable 
progress  in  A.'s  general  condition. 

Onanistic  tendencies  and  erections  at  night,  which  had  troubled  the 
patient  for  years,  disappeared  completely  under  the  influence  of  constant 
suggestion,  and  without  relapse.  His  general  condition  became  much 
better ;  there  were  but  slight  variations  of  his  mental  condition.  During 
this  month  he  had  to  complain  of  migraine  but  once  (October  25th).  His 
apprehensiveness,  which  had  driven  him  from  the  house,  disappeared. 
He  again  found  pleasure  in  writing,  spent  a  portion  of  his  evenings  at 
home  writing  a  story  he  had  begun  years  before.  Greater  interest  in  his 
business.  While  the  interest  in  the  opposite  sex  became  livelier,  during 
this  period  there  was  no  homo-sexual  excitement  of  any  kind. 

October  31st.  Again  for  the  first  time  intercourse  with  a  prostitute, 
with  unfavorable  physical  effect,  but  without  repugnance.  Continuance 
of  the  treatment  in  the  same  way  till  December  21,  1890.  Slow,  con- 
tinuous progress. 

November  9th  and  12th,  coitus  with  good  success  and  physical 
well-being,  but  erection  only  after  manipulation.  Decided  increase  of 
hetero-sexual  libido. 

November  16th.  In  an  attempt  at  coitus,  but  slight  manipulation 
necessary  to  induce  erection.  He  describes  his  condition  as  an  "  inner 
transformation  malgre  wiol"  There  is  still  interest  in  men,  but  no 
longer  any  desire  to  possess  them. 

November  20th.  Again  coitus  with  satisfactory  result  and  more 
intense  pleasure.  In  sexual  fancies  the  idea  of  a  woman  regularly  comes 
to  him. 

A  trip  of  two  weeks  to  Vienna  and  Linz  interrupts  the  treatment. 
After  his  return,  on  December  6,  1890,  the  patient  confesses  that  he  has 
attained  the  most  desired  object  of  his  life,  namely,  to  be  loved  by  a 
man.  The  second  relapse  ;  the  third  obstacle  to  treatment.  In  the  fol- 
lowing letter  the  patient  tells  how  it  all  came  about : — 

"Munich,  December  10,  1890.  Dear  Doctor:  Before  attempting 
to  give  a  report  of  the  events  of  my  absence  of  two  weeks,  I  will  first 
try  to  describe  the  success  of  the  treatment  to  which  I  have  now  been 
subjected  three  months.  Try  as  I  may  to  collect  my  thoughts  and  to 
conceive  a  picture  of  the  state  of  mind  in  which  I  was  before  the  jour- 
ney, I  can  make  nothing  of  it.  It  seems  to  me  that  all  that  was  before 
had  been  erased  ;  as  if  I  had  lived  only  since  I  loved  him.  Whether  I 
was  joyous  or  sad,  peaceful  or  depressed  ;  what  I  thought  of  my  condi- 
tion ;  whether  men  charmed  me  or  not — all  memory  of  it  is  gone.  All 
I  know  is  that  at  W.  I  was  very  busy,  and  that  I  spent  my  leisure  hours 
in  the  society  of  my  relatives  and  that  of  a  friend  (unreasonable).  Now 
all  my  thoughts  are  of  him.  All  longing,  hope,  and  desire  are  about 
him.  Only  his  image  is  before  my  soul ;  only  love  of  him  fills  my  heart. 

17 


258  SEXUAL    PARJ3STHESIA. 

What  shall  I  tell  you  of  the  feeling  that  animates  me;  that  makes  me 
happy  or  pains  me,  as  I  am  happy  in  possessing  him  or  miserable  at  the 
thought  of  losing  him  ?  You  wished  to  know  exactly  how  it  had  all 
come  about ;  and  I  will  try  to  tell  all  as  clearly  as  possible. 

"  Before  I  made  his  acquaintance  I  had  heard  of  him,  and  nothing 
but  good  report  of  his  character  and  his  heart;  so  that  I  was  very 
anxious  to  know  him.  At  first  I  did  not  please  him,  for  I  was  chilled 
after  a  long  journey,  and  the  changes  which  cold  induces  in  my  face  are 
usually  not  attractive.  I  hate  cold !  But  with  longer  association  I 
pleased  him  more  and  more, — how  I  do  not  know ;  he  began  to  be 
interested  in  me;  he  kissed  me  and  told  me  that  I  pleased  him,  that 
I  was  pretty,  that  he  loved  me.  At  last !  It  had  come  to  me !  My 
heart,  that  had  long  given  up  hope  of  being  loved,  was  warmed,  and  a 
new,  unknown  feeling  came  over  me.  I  saw  only  him;  I  wished  only 
for  him.  Had  the  world  vanished  around  me  I  should  not  have 
noted  it. 

"  Three  blissful  days  followed.  In  the  mornings  we  were  not 
together,  but  afternoons,  evenings,  and  the  nights.  Oh,  God,  I  thank 
Thee  that  once  in  my  life  Thou  hast  allowed  me  to  taste  the  bliss  of 
love!  Yes,  it  was  bliss, — unspeakable,  infinite  happiness.  I  had  him; 
I  felt  him  ;  I  possessed  him.  Ah,  it  would  have  been  too  much  mercy 
to  allow  me  to  die  in  his  arms !  For  years  I  had  prayed  for  nothing 
from  God  and  his  blessed  Mother  but  to  find  love.  I  repeated  my 
prayers  mechanically  after  the  formulas,  but  my  heart  cried  out  for  only 
one  thing, — love ;  give  me  love !  For  years  I  have  let  everything  go, 
lost  all  interest,  abandoned  my  literary  work,  done  my  business  perfunc- 
torily. Nothing  interested  me ;  nothing  attracted  me ;  without  love  all 
seemed  empty !  And  now  I  was  blessed.  All  thought  and  feeling  dis- 
appeared. It  was  like  an  ecstasy,  full  of  blessed  peace.  I  lay  on  his 
heart,  and  I  had  no  other  desire ;  it  was  all  to  me.  I  no  longer  know 
whether  the  time  was  long  or  short ;  I  only  know  that  it  passed,  and 
that  now  it  has  been  long  since  I  have  seen  him.  We  do  not  live  in  the 
same  city  ;  we  have  not  the  same  occupation  ;  the  possibilities  of  meet- 
ing are  not  great;  and  still  I  think  only  of  him.  I  pray  only  for  him.  If 
he  is  only  happy ;  if  all  goes  well  with  him ;  if  he  is  only  satisfied  and 
well.  I  can  do  nothing  for  him  and  be  little  to  him  ;  and  yet,  if  he  but 
wished  it,  I  would  give  up  everything ;  I  would  become  dead  and  lost 
to  my  relatives  ;  I  would  beg  with  him,  if  necessary. 

"  I  am  too  old  and  know  the  world  too  well  not  to  know  that  one 
cannot  always  be  at  the  height  of  such  feeling;  but  I  will  not  know  it; 
I  will  be  blind  ;  I  will  deceive  myself;  and  I  tremble  at  the  thought  of 
the  moment  when,  perhaps,  he  will  cease  to  love  me.  Oh,  God,  spare 
him  to  me!  I  know  well  that  physically  he  cannot  remain  true  to  me. 
I  do  not  desire  or  expect  that,  if  only  his  heart,  his  love,  remains  mine, 


CONTRARY    SEXUAL   INSTINCT.  259 

which  has  nothing  in  common  with  the  sensual  pleasure  which,  perhaps, 
he  experiences  temporarily  with  others.  I  remain  his;  for  me  no  other 
man  exists.  His  image  hovers  around  me ;  he  is  my  first  thought  on 
awaking,  my  last  on  falling  asleep.  I  stop ;  for  were  I  to  write  ten 
sheets  more  I  could  not  express  in  words  the  feeling  that  animates  me. 

"  With  truest  gratitude  for  your  help,  that  has  done  so  much  for 
me,  Sincerely,  A." 

In  answer  to  inquiry,  A.  added  that  he  lived  with  his  lover  three 
days,  and  that  he  repeatedly  performed  coitus  in  anum  on  him,  with 
spontaneous  ejaculation.  The  patient  protested  against  my  removing 
by  suggestion  this  inclination  in  which  he  found  his  perfect  happiness. 
Thinking  that  this  second  mood  would  also  pass,  that  then  I  should 
have  even  a  more  fertile  soil  for  suggestion,  I  limited  myself  to  sugges- 
tions of  ability  to  work  and  against  all  other  men. 

The  patient's  general  condition  has  scarcely  suffered  by  this  unfore- 
seen incident.  Now,  as  before,  the  nights  pass  quietly  and  without  the 
occurrence  of  erections  ;  no  inclinations  to  masturbate. 

The  prospect  of  seeing  the  lover  again  is  small,  owing  to  wide 
separation  ;  and  their  intercourse  is  limited  to  correspondence.  In  the 
week  after  his  return  the  patient  refuses  to  perform  coitus  with  a 
woman.  He  regards  that  as  being  false  to  his  most  sacred  feelings. 

Certain  of  my  final  victory,  I  considered  the  patient's  state  and 
limited  in}'  treatment  to  his  general  condition. 

December  14th  the  patient  came  in  great  depression,  and  reported 
that  the  very  cool  tone  of  his  lover's  last  letter  did  not  in  any  way  meet 
his  expectations. 

December  18th  the  patient  is  in  tears  because  of  despair  at  the 
conduct  of  his  lover  and  his  decisive  refusal  to  indulge  in  hetero-sexual 
congress.  He  wants  to  go  to  see  his  lover,  and  longs  for  the  day  of  his 
departure. 

Before  going  he  gives  me  a  written  report  concerning  the  final 
results  of  treatment  up  to  December  20,  1890,  which  had  not  been 
touched  by  the  "  relation."  The  letter  follows  : — 

"  Munich,  December  20, 1890.  Dear  Doctor:  In  obedience  to  your 
desire,  I  will  attempt  to  describe  the  success  that  has  attended  your 
treatment  of  me  during  three  months.  When,  late  in  August,  my  atten- 
tion had  been  excited  by  the  fifth  edition  of  von  Krafft-Ebing's  work, 
and  I  submitted  myself  to  you  to  gain  your  help,  my  condition  had  cer- 
tainly reached  its  acme.  The  melancholy  that  ruled  me  had  become 
complete  taedinm  vitse ;  the  thought  of  suicide  never  left  me,  and  often 
became  a  burden,  it  seemed  so  impossible  to  escape  it.  Nothing  else 
came  but  the  thought  of  how  most  quickly  and  painlessly,  and  with 
least  disgrace,  I  could  kill  myself. 


260  SEXUAL    PAILESTHESIA. 

"  In  this  state  of  mind  there  was  complete  indifference  to  every- 
thing; nothing  interested  or  attracted  me.  I  was  intensely  nervous, 
very  irritable,  moody,  and  incapable  of  resisting  every  emotion.  Besides, 
there  were  migraine,  sleeplessness,  and  the  constant  feeling  of  weariness. 
I  masturbated  daily,  and  was  so  excitable  to  my  own  sex  that  I  sought 
intercourse  with  men  every  day.  Often  I  had  to  use  all  my  strength  to 
control  my  eyes,  which  all  too  clearly  betrayed  my  feelings.  The 
thought  of  finding  no  love  threw  me  into  complete  despair,  and  made 
rne  miserable  physically  and  mentally. 

"  To-day,  after  three  months,  my  condition  is  essentially  better. 
The  melancholia  with  tsedium  vitse  has  disappeared;  and  if  still  some- 
times, owing  to  the  fact  that  I  have  very  depressing  business  cares,  I 
think, '  there  is  nothing  for  you  but  to  die,'  still,  that  does  not  ever  last 
long ;  after  a  few  moments  I  have  new  hope  and  do  not  consider  myself 
lost.  But  formerly  such  states  of  mind  lasted  hours  and  days ;  yes, 
even  weeks.  Further,  I  owe  it  to  your  suggestions  that  I  have  again 
begun  to  write, — an  occupation  which  I  had  entirely  abandoned  after  the 
first  reading  of  von  Krafft-Ebing's  book,  exactly  two  years  ago  (August, 
1888) ;  to  them  I  owe,  thus,  the  re-awakening  of  my  mental  interest. 

"  I  have  entirely  given  up  onanism  and  sexual  intercourse  with 
men.  Above  all,  I  am  happy  that  I  am  now  free  from  fancies  of  las- 
civious images, — that  prostitution  of  thought  which  formerly  was  busy 
with  nothing  but  ideas  of  unnatural  congress,  violation,  etc. ;  such 
thoughts  are  entirely  erased.  The  neurasthenic  troubles  are  very  much 
better  ;  only  once  during  my  last  journey  did  I  have  migraine.  Antipy- 
rin  and  valerian,  which  I  took  before  the  treatment,  I  no  longer  take. 
My  power  of  resistance  to  my  own  sex  has  become  so  great  that,  though 
I  could  easily  find  opportunity  for  it,  I  neither  seek  nor  miss  sexual 
congress  with  my  own  sex.  During  three  months,  until  this  meeting, 
as  you  know,  I  performed  coitus  with  women  regularly  weekly,  which 
before,  up  to  my  thirtieth  year,  I  had  performed  but  three  times.  My 
pleasure  in  my  own  sex  is  by  no  means  extinguished  .yet;  but  men  do 
not  charm  to  the  extent  they  did.  Now  I  should  not  desire  to  have 
intercourse  with  any  man,  unless  a  mental  sympathy  united  us.  Mere 
sensuality  has  lost  its  charm  for  me. 

"  For  all  this  I  thank  you,  Doctor,  for  I  should  never  have  known 
how  to  help  myself;  and,  too,  I  have  done  many  things,  like  sexual  inter- 
course witli  women,  only  as  a  result  of  the  inner  impulse  implanted  in 
me  by  suggestion, — an  impulse  that  was  at  first  foreign,  but  irresistible, 
and  which  I  obeyed  in  spite  of  myself.  Both  in  thought  and  desire, 
however,  I  feel  myself  too  much  like  a  woman  to  feel  fully  drawn  toward 
one  and  to  deny  my  inmost  nature. 

"  I  remain,  respectfully,  A." 

During  December  there  was  no  hetero-sexual  intercourse.     Other- 


CONTRARY    SEXUAL   INSTINCT.  261 

wise  his  condition  was  satisfactory.  From  December  26,  1890,  to  Jan- 
uary 4,  1891,  the  patient  was  with  his  lover  in  W.,  and  reveled  in  the 
happiness  of  requited  love.  Sexual  congress  every  night.  A.  returned 
filled  with  feelings  of  tenderest  love,  and  thoroughly  satisfied  aesthet- 
ically. The  months  of  January  and  February,  on  the  whale,  were 
marked  with  considerable  progress. 

During  the  first  half  of  January,  depression  and  complaint  of  cold- 
ness on  me  part  of  the  lover,  who  seemed  to  be  lazy  about  writing. 

January  1th,  the  patient  is  made  happy  by  postal  card;  great  de- 
light. The  treatment  was  continued  with  regularity,  as  formerly.  The 
patient  grows  quieter ;  his  passionate  feelings  slowly  change  to  those  of 
friendship,  and  in  the  second  half  of  January  it  is  possible  to  induce 
him  to  indulge  in  hetero-sexual  intercourse,  which  thenceforth  is  prac- 
ticed regularly. 

The  patient  again  becomes  as  he  was  in  November,  and  the  inter- 
current  love-affair  leaves  no  lasting  impression.  The  development  pro- 
ceeds slowly,  almost  imperceptibly,  in  the  hetero-sexual  direction. 

According  to  my  notes,  the  patient  performed  coitus  January  14th, 
21st,  31st;  February  3d,  10th,  14th,  17th,  21st,  24th,  28th  ;  March  3d, 
7th,  10th,  14th,  17th;  April  7th,  llth,  14th,  17th,  21st,  25th,  29th;  May 
5th,  7th  12th,  16th,  19th,  21st,  26th,  30th.  Erection  usually  induced  by 
manipulation  ;  seldom  spontaneous. 

At  the  end  of  January,  in  order  to  put  to  the  test  the  psycho-sexual 
transformation  that  had  been  induced  in  A.,  during  the  carnival  I 
allowed  him  to  mask  as  a  woman  twice.  In  this  costume  he  twice 
visited  balls,  but  he  no  longer  found  the  same  pleasure  in  his  role  as  for- 
merly, and  he  was  unable  to  react  on  this  occasion  to  the  solicitations 
and  allurements  which  were  not  to  be  misunderstood.  He  felt  cold  ; 
what  formerly  had  given  him  the  greatest  sensual  pleasure  seemed  to  be 
dead.  Too,  his  meeting  with  former  companions,  whose  society  he  had 
avoided  since  October,  made  no  impression  on  him.  As.  far  as  I  had 
occasion  to  observe  him  at  one  of  these  festivals,  I  may  say  that  his 
retiring  conduct  was  in  contrast  with  that  of  other  female  maskers 
(notorious  urnings).  A.  thus  stood  this  test  successfully. 

Owing  to  his  continued  progress  in  improvement,  after  February 
the  patient  was  hypnotized  only  once  or  twice  a  week.  During  this 
period  (February)  the  patient  once  wrote  me  as  follows : — 

"  To  my  great  regret  I  could  not  come  on  Thursday  on  account  of 
business.  I  have  had  the  desired  congress  with  a  woman,  and  not  once 
with  dislike  ;  indeed,  I  begin  to  have  a  greater  sexual  interest  in  women, 
so  that  on  the  occasions  of  sexual  excitement  my  imagination  is  prin- 
cipally concerned  with  feminine  forms." 

About  the  end  of  March,  a  journey  lasting  two  weeks,  but  without 
relapse.  Under  the  influence  of  suggestion  and  hetero-sexual  inter- 


262  SEXUAL    PAR^ESTHESIA. 

course,  there  is  gradually  developed  complete  inability  to  react  homo- 
sexually,  while,  on  the  other  hand,  the  relatively  (as  compared  with  inter- 
course with  men)  slight  pleasure  in  coitus  gradually  increases  in  intensity, 
and  inclination  to  perform  coitus  regularly  is  developed  into  a  necessity. 

In  May,  without  special  direction,  he  goes  to  women  spontaneously, 
and  is  thoroughly  convinced,  both  practically  and  theoretically,  of  the 
necessity  to  satisfy  his  sexual  desire  in  hetero-sexual  congress.  The 
number  of  hypnotic  sittings  to  which  the  patient  was  subjected  up 
to  the  beginning  of  June  was  one  hundred  and  eighteen.  A.'s  psycho- 
sexual  transformation  has  thus  lasted  five  months  without  relapse.  His 
mental  equilibrium  is  now  (June)  entirely  restored.  His  interest  in  the 
female  sex  has  not  reached  its  acme,  it  is  true,  but  its  intensity  has  so 
much  increased  that  the  thought  of  sexual  intercourse,  awake  or  in 
dreams,  is  closety  associated  with  the  idea  of  woman.  Onanistic  incli- 
nations and  painful  erections  have  not  occurred  in  six  months. 

His  physical  health  seldom  gives  any  reason  for  complaint.  His 
complexion,  formerly  altered  by  paint,  is  now  brown  and  healthy.  Now 
the  patient  does  not  dismiss  the  thought  of  marriage  as  formerly  ;  but 
as  yet  a  favorable  opportunity  has  not  presented  itself  to  him,  as  to  some 
others  of  my  patients.  The  patient  describes  his  own  improvement  in 
the  following  letter : — 

"  Munich,  May  13,  1891.  Honored  Sir :  In  attempting,  as  you 
desire,  to  describe  the  results  of  your  treatment  thus  far,  I  must  first 
declare  that  already  all  has  been  attained  that  I  originally  hoped  for  as 
a  result  of  hypnotic  treatment.  I  masturbate  no  more  and  feel  no  desire 
to  ;  the  great  depression  which  formerly  tormented  me  has  as  good  as 
disappeared  ;  my  mind  is  at  rest  and  perfectly  balanced.  My  feelings 
for  my  own  sex  have  essentially  changed  ;  the  love-relation  of  last  winter 
has  been  as  good  as  completely  erased  from  my  memory.  Correspond- 
ence has  ceased  for  two  months,  and  the  image  of  the  man,  whom  I 
loved  with  true  passion,  comes  before  my  mind  still  now  and  then  ;  but 
his  image  there  seems  only  as  that  of  something  dead  and  foreign  to  my 
inner  self. 

"  To  be  sure,  my  pleasure  in  powerful,  manly  figures  has  remained 
unaltered  ;  but  it  is  no  longer  accompanied  with  the  desire  to  possess  the 
person  pleasing  me  ;  rather  with  the  thought, '  If  I  were  only  like  you !' 
The  thought  of  sexual  relations  with  such  a  young  man  no  longer  meets 
with  any  response  in  me;  it  is  as  if  it  met  a  barrier.  I  begin  to  lose 
the  understanding  for  such  intercourse ;  men  no  longer  excite  me. 
Coitus  with  woman,  made  possible  for  me  by  your  successful  suggestive 
treatment,  has  become  a  habit ;  I  perform  it  regularly;  and  even  though 
the  lustful  pleasure  I  always  feel  in  it  is  not  so  strong  as  that  formerly 
experienced  in  intercourse  with  loved  men,  still  it  has  increased  in 
intensity,  and  the  feeling  of  satisfaction  has  become  greater. 


CONTRARY   SEXUAL   INSTINCT.  263 

"  The  lascivious  fancies  that  formerly  troubled  me  have  disappeared  ; 
occasionally  such  ideas  come  up  while  awake  and  while  dreaming;  but 
they  have  changed  ;  they  no  longer  are  of  the  sexual  act  of  man  with 
man,  but  of  intercourse  of  man  with  woman;  and  if  I  myself  am  con- 
cerned in  it,  I  take  an  active,  not  a  passive,  part.  The  feminine  charac- 
teristics that  still  cling  to  me  are  very  depressing  and  disturbing  to  my 
comfort ;  the  more  because  I  often  doubt  the  possibility  of  a  complete 
transformation  of  my  nature.  Adornment  and  toilettes  interest  me  as 
much  as  ever.  My  appearance  is  shy,  embarrassed,  and  timorous. 
Self-confidence  is  still  wanting,  and  I  fear  I  shall  never  attain  what  I 
admire  so  much  in  others, — namely,  that  certain  tone  of  energy  and 
decision  so  important  to  young  men. 

"  I  have  become  indifferent  to  my  external  appearance.  Powder 
and  paint,  cra3'on  and  rouge  I  have  long  abandoned  ;  but  formerly,  even 
on  days  when  I  was  nearest  despair,  I  always  carefully  made  my  toilet ; 
the  half-genuine,  half-feigned  airfaue,  farde,  retape  seemed  to  me  indis- 
pensable to  complete  my  personality.  Under  the  influence  of  suggestion 
the  physical  troubles,  painful  erections  at  night,  migraine,  etc.,  have 
disappeared  entirely;  I  feel  fresh  and  health}".  After  hypnotic  sittings 
I  have  never  felt  any  way  but  perfectly  well.  My  interest  in  my  busi- 
ness, as  in  my  literary  work,  .is  re-awakened;  the  feeling  of  anxiety 
when  alone  has  completely  disappeared.  I  have  begun  to  smoke.  The 
pictures  of  celebrated  urnings  have  disappeared  from  my  walls  to  give 
place  to  those  of  a  certain  celebrated  comedienne. 

"  To  express  in  a  word  all  that  has  thus  far  been  attained,  I  may 
say  that  in  sexual  relations  I  feel  neutral  and  healthy.  Males  no  longer 
charm  me ;  and  though  I  begin  to  have  interest  in  girls  (which  I  never 
did  formerly),  still  they  do  not  excite  me.  Were  I  to  choose  between 
being  a  man  or  a  woman,  I  should  certainly  choose  to  be  a  woman ;  and, 
believe  me,  I  should  be  a  good,  virtuous  wife. 

"  In  gratitude  and  respect,  A." 

"  Postscript :  Doctor,  please  change  '  large  hands.'  I  wear  7^ 
gloves,  and  that  is  not  large  ;  and  my  hands  are  perfectly  white.  No 
one  has  ever  called  my  hands  large.  Please  cut  that  out,  will  you 
not?"1 

There  cannot  be  the  slightest  doubt,  from  the  foregoing 
details,  that  suggestion  exercised  the  greatest  influence  in  the 
psycho-sexual  transformation  and  the  mental  and  physical 
restoration  of  A.  Should  the  patient  continue  in  the  same 

1  In  the  "  status  praesens  "  I  wrote  at  first  "  large  hands."  When  I  read  the  history 
to  the  patient  he  protested  against  it,  and  repeated  his  very  characteristic  objection  in  his 
last  letter. 


264  SEXUAL    PARjESTHESIA. 

course  his  defect  will  give  little  cause  for  relapse.  It  is  also  to 
be  hoped  that  the  effemination,  which  continues  as  before,  will 
gradually  undergo  a  transformation  in  the  sense  of  a  masculine 
and  active-feeling  personality,  to  which,  however,  the  unalter- 
able fixity  of  certain  existent  associations  in  the  central  ner- 
vous system  will  probably  oppose  a  definite  and  impassable 
limit.  But  in  this  event  the  ultimate  possibility  of  human 
knowledge  and  therapeutics  will  have  been  attained. 

Additional  Notes. — My  absence  from  Munich  for  two  months  and  a 
half — from  June  to  September,  1891 — brought  about  a  pause  in  the 
treatment  of  the  patient.  During  this  time  he  had  a  relapse,  though 
not  in  the  strict  sense  of  the  word.  Concerning  this  he  wrote,  on  Sep- 
tember 1st : — 

"  Simply  from  ennui,  and  in  order  to  experience  erection  again,  I 
went  to  the  parks  and  got  up  some  associations.  It  would  be  lying  to 
say  that  it  made  me  happy  and  that  my  heart  was  in  it.  Many  times  it 
wearied  me.  The  tenderness  of  the  men  touched  me,  but  this  male 
intercourse  did  not  charm  me  as  of  old." 

Thus,  not  in  obedience  to  his  abnormal  instinct,  but  merely  to 
break  the  monotony  of  female  intercourse,  the  patient  sought  out  the 
places  of  former  meetings.  But,  as  we  see,  his  attitude  toward  the 
homo-sexual  acts  was  inwardly  changed.  He  is  undeceived,  and  only 
his  pity  for  his  partner  induces  him  to  continue  the  relations  and  not 
break  them  off  abruptly.  At  the  same  time,  we  see  that  the  patient  is 
not  yet  able  to  get  on  without  the  moral  influence  of  the  physician. 
Otherwise  he  is  devoid  of  moral  defect,  and  this  deficiency  must  be 
overcome  by  continued  help. 

Resumption  of  hypnotic  treatment  in  the  beginning  of  September. 
Interruption  of  the  homo-sexual  relations  ;  normal  sexual  intercourse 
regularly  once  a  week.  During  the  eight  months  since  the  relapse  the 
patient  has  not  manifested  his  former  inclinations  in  any  way.  He  is 
still  hypnotized  once  a  week;  very  busy  in  his  calling.  His  neurasthenic 
symptoms  have  entirely  disappeared,  and  he  makes  no  complaints.  In 
some  points  his  effemination  seems  to  have  weakened.  He  appears 
calm  and  earnest  and  in  accord  with  his  surroundings.  Up  to  the 
present  time  there  have  been  twenty-four  hypnotic  sittings  (one  hundred 
and  twenty-four  in  all). 

The  patient  continues  under  observation.  In  this  case,  in  a  de- 
generate individual,  who  has  been  under  treatment  one  year  and  eight 
months,  the  result  of  treatment,  in  spite  of  the  mental  weakness,  should 
be  of  great  interest  in  the  prognosis  and  treatment  of  similar  severe 
cases. 


CONTRARY   SEXUAL   INSTINCT.  265 

Case  64.  Personal  Observation.  Contrary  Sexual  Instinct  Treated 
in  Seven  Hypnotic  Sittings  without  Success. — W.,1  aged  40 ;  artist.  His 
parents  were  healthy.  Father  passionate  sexually,  tour  times  married. 
Patient  had  scarlet  fever  and  typhoid  in  youth.  Otherwise  healthy. 
Asthma,  due  to  corpulence.  At  the  age  of  7,  he,  like  his  brother,  was 
taught  onanism  by  one  of  his  father's  servants.  Love  of  men  in  his 
thirteenth  year.  Neither  at  that  time  nor  later  did  women  make  the 
slightest  impression  on  him.  Complete  fiasco  in  attempt  at  coitus ;  no 
erection.  During  his  school-days,  mutual  onanism  and  auto-masturba- 
tion. Repeatedly  in  love  with  young  men  aged  from  18  to  22.  W.  re- 
gards his  anomaly  as  congenital ;  feels  unhappy.  His  last  relation  was 
with  one  of  his  scholars.  He  met  with  no  return  of  affection  and  was 
tortured  with  jealousy.  On  the  advice  of  a  celebrated  physician,  who 
regarded  abstinence  as  sufficient  to  induce  recovery,  he  attempted  to 
give  up  masturbation  and  homo-sexual  love.  But  this  made  him  only 
the  more  unhappy,  and  caused  him  to  believe  that  happiness  was  im- 
possible for  him.  The  patient  dreams  but  little;  pollutions  infrequent, 
though  he  masturbated  two  or  three  times  daily.  Formerly  he  liked  to 
associate  with  ladies,  attracted  by  their  mental  qualities,  though,  on  the 
whole,  he  preferred  the  society  of  men.  Of  late  he  had  become  more 
retiring,  out  of  fear  of  being  discovered. 

Patient  looks  upon  a  cure  as  his  salvation.  He  applied  to  Profes- 
sor von  Krafft  Ebing,  who  persuaded  him  to  try  hj'pnosis  with  me. 

The  patient  presented  himself  on  August  19th. 

He  is  of  stately,  manly  appearance  (has  made  two  campaigns),  and 
is  devoid  of  degenerate  signs.  Pelvis  and  genitals  masculine.  Abundance 
of  genital  hair;  no  beard.  Tone  of  voice  feminine;  dress  elegant.  Uses 
a  fan  to  cool  himself, — a  thing  he  always  carries.  On  the  whole  he  makes 
an  effeminate  impression.  Movements  restless  ;  gait  weaving. 

The  patient  is  able  to  remain  in  Munich  but  six  da3^s  more.  I  tell 
him  that  in  so  short  a  time  no  lasting  impression  can  be  made  upon 
a  trouble  that  has  existed  thirty  years.  Nevertheless  he  wishes  to  learn, 
by  means  of  six  sittings,  whether  he  is  amenable  to  suggestion. 

August  19,  1890.  First  attempt.  Slight  symptoms  of  somnolence. 
The  patient  watches  procedures  with  too  close  attention.  Difficult  for 
him  to  raise  his  63'elids.  Auto-suggestive  catalepsy  interrupted  volun- 
tarily. The  therapeutic  commands  are  directed  only  to  general  health 
and  disinclination  to  onanism. 

August  20th.  No  inclination  to  masturbate  in  the  first  twenty-four 
hours.  He  slept  remarkably  well,  which  he  ascribes  to  the  treatment. 
To  intensify  the  effect,  to-day  I  have  him  look  at  a  shining  button  for 
five  minutes.  Sleep-suggestion  (Lie*beault-Bernheim).  No  interruption 

1  Comp.  von  Krafft-Ebing,  Neue  Forschungen  auf  dem  Gebiete  der  Psycbopathia 
Sexualis,  2  Aufl.,  p.  116,  Beob.  6  (Enke,  Stuttgart,  1891). 


266  SEXUAL    PAR^ESTHESIA. 

of  sleep  by  attempts  at  catalepsy.  Patient  sleeps  for  half  an  hour, 
snoring  loudly.  Suggestions:  Repugnance  for  onanism ;  indifference 
for  men  ;  gradually  awakening  interest  in  women.  After  waking,  patient 
says  he  has  slept  well. 

August  21st.  Mood  somewhat  brighter.  No  inclination  to  onan- 
ism, but  no  inclination  for  women.  Procedure  as  on  the  20th ;  fixation 
shorter.  Suggestion  to  attempt  coitus. 

August  22d.  Last  night,  though  the  patient  dreamed  of  men,  he 
did  not  masturbate  in  spite  of  erection.  Yesterday  he  tried  to  make  the 
acquaintance  of  a  woman  in  the  park,  but  he  was  not  successful,  and  is 
much  depressed  by  his  failure. 

August  23d.  Procedure  and  suggestions  as  on  the  21st.  Energetic 
command  to  perform  coitus. 

August  24th.  Yesterday  he  was  able  to  overcome  his  shjmess.  He 
followed  a  prostitute  to  her  house.  Here  he  had  to  pass  a  room  in  which 
a  man  lay  asleep.  The  doors  were  not  locked.  This  accident  at  once 
awakened  W.'s  suspicions.  He  immediately  lost  courage,  and  departed 
frightened,  without  making  any  attempt.  General  condition  good. 
Hypnotic  procedures  as  usual. 

August  25th.  Last  sitting.  Certain  success  of  an  attempt  at  coitus 
promised.  In  spite  of  my  request,  W.  has  reported  nothing  further 
concerning  his  condition. 

In  the  foregoing  case,  success  after  so  short  a  period  of 
treatment  was  not  to  be  expected.  Still,  from  the  sittings  it 
showed  that  W.  was  amenable  to  hypnosis  and  to  suggestions 
of  a  sexual  nature.  In  all  probability  essential  improvement 
would  have  followed  prolonged  treatment. 

Case  65.  Personal  Observation.  Acquired  Contrary  Sexual  In- 
stinct Improved  in  Seven  Hypnotic  Sittings. — Mr.  P.,  aged  25  ;  official  in 
a  manufactory  ;  brother  of  the  subject  of  Case  62.  (The  diseases  of  other 
members  of  the  family  given  there  in  detail.)  Neuropathic  taint.  Early 
awakening  of  sexual  instinct ;  onanism  without  teaching.  At  the  age 
of  16  he  visited  brothels  and  enjoj'ed  coitus,  but  he  also  satisfied  him- 
self with  frequent  masturbation.  After  his  twentieth  year,  sexual  ex- 
cesses with  prostitutes.  Neurasthenia  sexualis  (weakness  of  erection, 
premature  ejaculation).  Relative  impotence.  Frequent  onanism.  In 
1888  he  fell  in  love  with  a  man.  With  this  his  love  of  women  disap- 
peared. A  second  relation  followed  the  first.  Once  he  locked  a  soldier 
in  a  room,  commanded  him  to  undress,  and  to  go  to  bed  with  him.  His 
demand  was  immediately  complied  with.  Mutual  onanism.  The  patient 
abused  many  men  in  this  way  without  actually  falling  in  love.  Threat- 
ening letters.  Deep  depression.  Thoughts  of  suicide. 


CONTRARY    SEXUAL    INSTINCT.  267 

At  the  advice  of  his  physician,  the  patient  came  to  me  in  Munich, 
in  Ma}%  1889,  to  be  treated  bypuoticallj.  Besides  his  perversion,  the 
patient  has  suffered  for  more  than  a  year  with  sleeplessness  which  has 
not  yielded  to  medicines,  headaches,  and  other  neurasthenic  complaints. 

May  20th.  First  hypnotic  attempt  after  the  method  of  Bernheim. 
Slight  lethargy.  Suggestions:  (a)  Repugnance  for  on  an  ism.  (6)  Dis- 
inclination for  men.  (c)  Interest  in  the  female  sex.  (d)  Undisturbed 
deep  sleep  at  night  and  subjective  feeling  of  well-being. 

May  21st.  To-day  suggestive  catalepsj" ;  hypotaxis ;  no  amnesia 
after  waking.  Suggestions  like  those  of  yesterday. 

May  22d.  Last  night  the  patient  slept  six  hours  undisturbed  and 
without  dreams,  which  he  regards  as  a  great  blessing.  Suggestions  as 
yesterday.  Diminution  of  homo-sexual  inclinations,  according  to  his 
statement. 

May  23d.  Five  hours  of  sleep  last  night.  No  more  inclinations  to 
masturbate.  Procedure  and  suggestions  as  on  the  20th. 

May  24th.  Six  hours  of  excellent  sleep  last  night.  He  states  that 
there  is  no  more  inclination  for  men.  Procedure  and  suggestion  as  on 
the  20th.  To-day  the  patient  is  given  suggestions  with  reference  to 
undertaking  normal  sexual  intercourse. 

May  26th.  To  my  surprise,  I  received  the  following  letter  from  the 
patient : — 

"  Dear  Doctor  :  I  %beg  you  to  allow  me  to  inform  you  that  I  am 
cured  of  all  my  trouble  to  the  best  of  my  desires.  There  is  no  more 
sleeplessness.  Toothache  and  armache  have  gone,  and  I  shall  easily 
overcome  the  rest,  I  am  convinced.  I  have  already  entered  into  a  love- 
affair.  I  am  about  to  take  a  mountain  trip  to  quiet  and  rest  my  nerves. 
Accept  my  best  thanks  for  this  recovery,  which  I  shall  never  forget. 

"  Very  respectfully,  P." 

The  foregoing  lines  I  answered  by  writing  that  I  should  be  com- 
pelled to  suspend  treatment  if  circumstances  made  it  impossible  for  him 
to  remain  longer  in  Munich,  but  that  I  could  not  agree  with  him  in 
regarding  temporary  slight  improvement  as  a  cure. 

The  experience  of  the  next  year  demonstrated  the  correctness  of 
my  opinion.  In  March,  1890,  a  relation  of  the  family  consulted  me 
concerning  a  new  relapse  of  the  patient.  I  strongly  advised  a  resump- 
tion and  long  continuance  of  hypnotic  treatment.  Since  a  prolonged 
stay  in  Munich  was  impossible,  the  patient  decided,  at  my  advice,  to 
submit  to  treatment  at  the  hands  of  Professor  von  Krafft-Ebing,  in 
Vienna.  The  professor  began  hypnotic  treatment  April  8,  1890. 

On  April  14th  the  patient  was  able  to  report  that  "  with  gratitude 
and  a  kind  of  moral  satisfaction  "  he  had  had  coitus  with  enjoyment, 
but  had  ejaculated  tardily. 


268  SEXUAL    PAR^STHESIA. 

The  following  report  by  letter  to  Professor  von  Krafft-Ebing,  on 
October  20th,  would  indicate  that  the  cure  was  permanent : — 

"  I  am  completely  cured  of  onanism,  and  homo-sexual  love  no 
longer  pleases  me.  Complete  power  does  not  seem  to  have  been 
attained,  though  I  lead  a  virtuous  life.  Nevertheless,  I  am  satisfied." 

In  the  spring  of  1891  I  learned  that  the  patient  had  had  relations 
with  a  girl  in  the  country  and  had  become  a  father. 

In  some  respects  the  foregoing  case  is  instructive.  In  the 
first  place,  like  other  cases  here  reported,  it  clearly  shows  that 
contrary  sexual  instinct  is  decidedly  amenable  to  treatment  by 
suggestion.  Further,  it  illustrates  how  such  patients  may  easily 
deceive  themselves,  and  teaches  that  with  reference  to  the  time, 
number  of  sittings,  repetition  of  the  procedures,  and  continuance 
of  observation  after  discharge,  the  treatment  must  be  conducted 
in  accordance  with  the  severity  and  the  development  of  the 
psycho-sexual  anomaly.  The  results  of  the  sexual  relation,  as 
shown  in  this  case  in  the  begetting  of  a  child,  which  was  con- 
templated neither  by  physician  nor  patient,  show  that  sexual 
relations  should  be  limited  to  prostitutes,  and  later  to  actual 
marriage,  in  spite  of  many  opposing  considerations.  Since  we 
are  unable  to  keep  such  individuals  from  propagating  descend- 
ants, the  least  danger  to  society,  relatively,  lies  in  allowing  them 
sexual  gratification  in  marriage, — especially  when  it  is  remem- 
bered that  there  is  a  possibility  of  properly  educating  and 
training  the  children  of  such  parentage,  in  case  they  show 
hereditary  taint.  The  physiological  demand  for  satisfaction  of 
the  sexual  instinct  is  usually  stronger  in  man  than  the  power 
of  any  moral  knowledge ;  that  is,  the  desired  complete  depend- 
ence of  the  sexual  functions  upon  ethical  ideas.  Therefore  we 
are  forced  to  choose  the  lesser  of  two  evils. 

Case  66.  Personal  Observation.  Contrary  Sexual  Instinct  De- 
pending on  a  Congenital  Neuropathic  Constitution  Cured  in  Two 
Hundred  and  Four  Hypnotic  Sittings.  Period  of  Observation,  One 
Year  and  Five  Months. — Mr.  H.  consulted  me  October  9,  1890.  His 
father  is  a  drinker  (fatty  heart).  Mother  healthy.  An  uncle  is  also 
subject  to  contrary  sexual  instinct.  One  brother  neurasthenic  and  an 
onanist;  another  said  to  be  healthy.  Sister  (aged  19)  hysterical.  Be- 
sides, several  relatives  on  the  father's  side  subject  to  pulmonar}'  disease. 

Patient,  aged  24,  born  on  the  island  K.,  near  Australia.     There  he 


CONTRARY   SEXUAL   INSTINCT.  269 

had  the  diseases  of  childhood,  and  was  brought  to  Europe  when  8  years 
old  and  placed  in  school  in  S.  During  the  time  from  his  eighteenth  to 
his  twenty-first  year  the  patient  had  a  severe  inflammation  of  the  lungs 
and  pleura  and  two  attacks  of  rheumatism.  H.,  a  merchant  by  occupa- 
tion, suffers  with  congestive  attacks,  frequent  headaches,  feelings  of 
fatigue,  depression,  want  of  endurance  and  energy,  and  at  times  with 
absolute  inability  to  work  and  tachycardia.  These  neurasthenic  troubles 
have  existed  for  years,  and  have  been  a  hindrance  to  regular  occupation. 
Status  praesens:  Tall,  slim,  well-nourished.  Face  ruddy;  the  form 
of  the  cranium  shows  nothing  remarkable.  The  measurements  are  : — 

Horizontal  circumference, .57  cm. 

Posterior  half-circumference, 24  cm. 

Anterior  half-circumference, 29  cm. 

Vertex-line,    .         .         . . ' 36  cm. 

Antero-posterior  line, 28  cm. 

Chin-line, 31  cm. 

Long  diameter,       .         . 17  cm. 

Broad  diameter, .13  cm. 

Diameter  between  the  auditory  meati,  .  .  .'  .  12  cm. 
Diameter  between  zygomatic  processes,  .  .  .11  cm. 
Distance  from  auditory  meatus  to  nasal  spine,  .  .  12  cm. 

Head  nowhere  sensitive  to  pressure.  Pupil-reactions  normal. 
Eyes  have  a  neuropathic  expression.  No  objective  disturbance  of  sen- 
sation or  motion.  Neck  remarkably  long;  tendency  to  struma.  Chest 
flat.  Breasts  masculine  in  development.  The  pl^-sical  examination  of 
heart  and  lungs  gives  a  negative  result.  Genitals  well  developed,  large ; 
abundance  of  genital  hair.  Prepuce  easily  retracted  beyond  the  glans ; 
skin  well  cared  for, — delicate  and  fine.  The  facial  type  is  not  very  manly, 
— rather  boyish.  Growth  of  hair  on  head  abundant ;  slight  moustache. 
Hair  blonde.  Tissues  soft ;  abundant  adipose;  muscles  fairly  developed 
for  age.  On  the  whole,  delicate,  weak  constitution.  Position  of  the 
thighs  straight. 

MEASUREMENTS  OF  PELVIS. 

Diameter  at  anterior  superior  spines,    .         .         .         .21  cm. 

Diameter  at  crests, 25  cm. 

Diameter  at  tubera  ischii, 8-9  cm. 

Diameter  at  trochanters, 29  cm. 

Diameter — external  conjugate, 17  cm. 

Form  of  pelvis  asymmetrical ;  slight  oblique  distortion.  On  the 
left  side  the  ilium  and  the  trochanter  are  1.5  centimetres  higher  than 
on  the  right.  Voice  baritone.  Attire  elegant,  without  exaggeration 
for  effect. 


270  SEXUAL    PAR^STHESIA. 

Development  of  H.^s  Homo-sexual  Inclinations  and  Character. — The 
patient  asserts  that  in  his  youth  he  developed  in  the  direction  of  male- 
love.  He  was  quiet  and  retiring ;  never  had  especial  pleasure  in  boys' 
play,  and  was  always  joked  about  his  girlishness.  In  his  boyhood  he 
preferred  the  society  of  girls,  and  when  a  child  he  was  happy  when  he 
could  see  handsome  men.  All  noisy  and  boisterous  conduct  he  hated  ; 
on  the  other  hand,  he  early  showed  a  taste  for  female  toilettes,  fashions, 
and  housework.  He  was  always  considered  an  excellent  judge  and 
adviser  in  matters  of  feminine  dress. 

At  the  age  of  6,  seduced  to  it  by  a  playmate,  he  first  had  a  thought 
to  touch  a  companion's  genitals,  which  gave  him  lustful  feelings.  Since 
then  he  has  had  sexual  intercourse  only  with  men.  Immediately  after 
hearing  his  histoiy,!  asked  the  patient  whether  the  feminine  inclinations 
appeared  before  or  after  the  first  occurrence  of  sexual  excitement.  He 
was  not  able  to  remember,  but  he  had  the  impression  that  the  manifesta- 
tions of  efl'emination,  which  were  not  very  markedly  developed,  had 
resulted  from  his  sexual  perversion. 

In  this  case,  also,  the  influences  of  education  were  determinate  in 
directing  H.'s  sexual  inclination,  predisposed  as  he  was  by  heredity. 
From  his  thirteenth  to  his  seventeenth  year,  while  a  student  at  a  gym- 
nasium, he  gave  himself  passionately  to  solitary  and  mutual  onanism, 
and  it  was  always  accompanied  by  fancies  of  homo-sexual  content, 
though  at  that  time  he  had  no  clear  understanding  of  the  sexual  rela- 
tions. A  relation  with  a  sailor,  which  lasted  six  months  in  the  year 
1883,  to  which  H.  alludes  in  his  autobiography,  which  follows,  gave 
him  what  he  calls  the  happiest  period  of  his  life.  He  loves  to  see  pow- 
erful forms,  and  quite  frequently  has  erections  at  such  a  sight.  Owing 
to  his  weak  constitution  he  was  not  compelled  to  take  gymnastics,  and 
he  avoided  manly  sports.  As  a  rule,  he  does  not  dream,  but  he  remem- 
bers that  in  sexual  dreams,  with  pollutions,  he  always  thought  of  hand- 
some men.  He  does  not  seek  to  attract  attention  by  striking  attire ; 
on  the  whole,  he  is  modest,  retiring,  and  of  quiet  disposition.  His  libido 
is  not  strongly  developed. 

He  esteems  the  female  sex,  and  likes  to  associate  with  ladies,  but 
without  ever  being  sexually  excited  by  them  ;  it  was  the  same  in  his 
earliest  youth.  In  the  patient's  ancestry  no  indications  of  an  homo- 
sexual tendency  can  be  discovered,  which,  according  to  Moll,  would  be 
decisive  for  the  diagnosis  of  congenital  contrary  sexual  instinct.  The 
patient  does  not  smoke  or  drink.  Great  love  of  art  and  the  theatre.  H. 
is  a  fine  singer.  He  has  talent  for  languages.  Gentle  disposition,  but 
irritable.  On  the  whole,  a  simple,  yielding  character,  somewhat  shy. 
His  education  and  reading  gave  him  an  understanding  of  his  condition, 
though  somewhat  late.  He  regards  himself  as  a  step-child  of  nature,  and 
is  very  unhappy  and  depressed  because  he  sees  his  existence  a  failure, 


CONTRARY   SEXUAL   INSTINCT.  271 

owing  to  his  powerlessness  to  overcome  bis  abnormal  impulse.  His 
sexual  desires  are  not  so  strong  as  in  many  other  patients,  but  they  are 
exclusively  directed  to  the  male  sex.  Patient  has  never  performed 
coitus;  hetero-sexual  intercourse  is  inconceivable  to  him.  Horror 
feminse.  He  abhors  pederasty ;  simply  touching  the  genitals  of  his 
companion,  mutual  ouanism,  or  simply  embraces  and  kisses,  induce 
ejaculation.  Besides  there  are  the  neurasthenic  troubles  previously 
mentioned. 

Autobiography. — "  It  may  have  been  five  years  ago  that  I  came  to 
understand  my  condition  through  an  article  by  Prof,  von  Krafft-Ebing. 
It  was  as  if  a  bandage  had  been  removed  from  my  eyes  ;  and  the  result 
was  that  I  became  quieter.  Before  that  I  seemed  a  criminal  in  my  own 
eyes. 

"  As  far  as  I  can  remember,  the  feelings  in  question  occurred  first 
in  my  sixth  3'ear.  It  was  in  K.,  in  the  society  of  a  boy  of  our  neighbor- 
hood, that  I  soon  came  into  sexual  relations,  which  consisted  of  mutual 
fondling  of  the  genitals.  About  the  same  time  there  was  a  ship-carpenter 
working  on  our  square,  who  was  also  given  work  on  our  place  during  his 
stay  in  the  harbor.  Since  his  appearance  was  very  attractive  to  me,  it 
was  not  long  before  I  had  an  intense  desire  to  touch  his  genitals.  I 
hung  around  him,  and  one  day  expressed  to  him  my  desire,  which  he, 
of  course,  refused  to  fulfill.  When  I  was  8  years  old  we  made  the  jour- 
ney to  Germany,  and  we  did  not  take  the  short  way  via  America,  but 
passed  round  South  America  in  a  sailing-vessel.  The  voyage  lasted 
four  months.  Among  the  sailors  I  soon  found  a  young  man  on  whom 
in  a  short  time  I  was  entirely  dependent.  Whenever  he  was  free  I  was 
'b}r  his  side,  but  there  were  never  improper  relations. 

"  The  first  two  years  and  a  half  in  Germany  we  lived  in  S.,  and  they 
passed  without  special  event  for  me.  We  later  moved  to  L.  During 
the  last  summer  of  our  stay  there,  owing  to  awakening  intense  sexual 
desire,  I  sought  schoolmates  who  pleased  rne  by  their  handsome  appear- 
ance, and  seduced  them  to  mutual  onanism.  From  this  time  until  my 
seventeenth  year  I  masturbated  a  great  deal.  I  was  especially  led  to  it 
by  the  following  circumstance:  From  the  winter  of  1880-81  we  again 
lived  in  S.,  where  I  attended  the  gymnasium.  After  a  short  time  our 
family  physician  caused  me  to  be  taken  from  school  for  a  term,  owing  to 
the  fact  that  the  first  signs  of  pulmonary  weakness  were  shown  at  that 
time.  Owing  to  the  freedom  which  I  now  enjo}red,  I  soon  came  to  yield 
more  frequently  to  my  inclinations.  Since  my  mind  was  not  given  suf- 
ficient employment,  I  had  plenty  of  time  to  spend  in  feeding  my  fancy  on 
the  images  of  the  powerful,  handsome  men  I  saw.  The  unsatisfied 
longing  for  my  beloved  objects,  whom  I  only  saw  afar,  drove  me  to  self- 
abuse  for  want  of  something  better.  During  these  years  I  had  no  inter- 
course with  companions  or  men. 


272  SEXUAL    PAR^ESTHESIA. 

"  At  the  wish  of  our  pli3?sician  I  left  the  gymnasium,  after  having 
obtained  the  certificate  absolving  me  from  all  but  one  year  of  military 
service,  and  began  as  an  apprentice  in  a  business  in  S.  Since  I  had  hard 
work,  during  the  first  year  of  my  service  I  was  not  excited  sexually. 

"  In  1883  I  accidentally  made  the  acquaintance  of  a  sailor  who,  at 
the  time,  was  making  the  so-called  "  short  voyage,"  and  therefore  was 
much  at  home;  that  is,  he  often  came  to  S.  He  was  happily  married 
and  had  four  children.  At  first  sight  I  was  dead  in  love  with  the  man, 
and  I  spared  no  pains  to  meet  him  as  often  as  possible.  We  soon  became 
intimate  friends.  I  desired  nothing  more  intensely  than  to  be  able  to 
associate  with  him  sexually,  but  I  was  too  shy  to  speak  of  such  a  thing 
to  him.  One  day  he  himself  gave  occasion  for  it  by  proposing  onanism 
directly.  From  that  time  I  passed  months  of  happiness  ;  for  I  felt  more 
elastic  and  more  capable  of  work.  I  can  only  explain  the  conduct  of 
my  friend  by  the  fact  that  he  was  very  strong  and  had  a  corresponding 
need  of  sexual  satisfaction  which  he  could  not  seek  with  his  wife,  owing 
to  the  necessities  of  a  growing  family.  At  any  rate,  he  was  in  no  sense 
male-loving.  My  intercourse  with  him  was  suddenly  terminated  by  my 
falling  ill  with  pneumonia  and  pleurisy,  which  were  followed  by  two 
attacks  of  rheumatism,  and  I  was  confined  to  the  bed  seven  months  out 
of  twelve.  When  I  had  recovered,  my  lover  had  been  called  away  and  I 
lost  sight  of  him.  Thereafter  I  was  not  able  to  make  another  friend 
like  him  with  whom  I  had  found  satisfaction  for  my  desires.  A  certain 
restraint,  as  well  as  the  assumption  that  it  was  injurious  to  me,  if  I 
could  not  have  natural  feelings,  to  yield  to  my  unnatural  impulse,  held 
me  a  little  in  check. 

"  Three  years  ago  I  became  acquainted  with  a  merchant,  three  years 
my  senior,  who  is  still  unmarried.  Since  we  held  similar  views  on  many 
subjects,  the  relation  grew  more  and  more  intimate.  On  his  part  it 
seemed  to  me  to  be  warm  friendship ;  on  my  part,  from  affectionate 
attachment  there  was  developed  a  love  ready  for  any  sacrifice.  I  sought 
to  restrain  myself,  and  succeeded.  After  our  friendship  had  lasted  a 
year  I  left  S.,  and,  after  a  trip  of  two  months,  reached  N.  with  my 
brother.  My  stay  there  lasted  eighteen  months;  and  it  is  remarkable 
that  I  lived  there  very  happily  and  undisturbed.  This  was  due  to  the 
simple  life  of  the  town,  the  kind  of  food,  and  the  nature  of  the  society 
there.  After  having  taken  a  position  in  S.,  in  June  of  this  year,  it  was 
soon  very  different.  The  quiet  life  was  over.  The  work  in  the  store 
was  often  very  taxing,  and  during  leisure  hours  more  social  demands  than 
usual  were  made  on  me ;  and  naturally,  leading  such  a  life,  I  was  excited 
more  than  was  well  for  me.  As  soon  as  I  arrived  in  S.,  one  of  my  first 
visits  was  on  my  friend  previously  mentioned.  My  feeling  for  him  had 
remained  unchanged,  or  was  rather  intensified.  During  the  summer 
months  we  often  met,  evenings;  and,  since  my  passion  constantly 


CONTRARY    SEXUAL   INSTINCT.  273 

increased,  I  once  embraced  and  kissed  him.  Contrary  to  my  expecta- 
tions, he  warmly  returned  my  caresses.  In  this  I  had  an  ejaculation. 
After  that  I  sought  such  opportunity  as  often  as  possible,  and  I  lived  in 
a  happiness  of  requited  love.  When,  however,  I  once  sought  to  touch 
his  genitals,  he  would  not  suffer  it ;  and  since  then  he  has  avoided  being 
alone  with  me. 

"  This  is  the  history  of  my  errors.  I  longed  to  be  freed  from  a 
condition  that  has  so  often  placed  me  in  the  most  painful  positions, 
because  toward  men  who  were  dear  to  me  I  felt  unnatural  love.  I  would 
learn  to  have  warm,  practical  friendship.  I  will  also  mention  that  with 
my  first  lover,  the  sailor,  I  felt  intense  jealousy  when  I  saw  that  he  cast 
friendly  glances  on  other  women  than  his  wife. 

"  Since  my  seventeenth  year  I  have  practiced  onanism  only  very 
infrequent!}'. 

"  It  only  remains  to  mention  my  position  in  relation  to  the  female 
sex.  As  a  school-boy  I  could  not  understand  how  my  companions 
could  run  after  girls.  On  all  occasions  I  showed  the  girls  that  they  were 
indifferent  to  me.  Later,  my  companions  visited  public  prostitutes.  It 
was  very  unpleasant  to  me  to  think  of  what  took  place  under  such 
circumstances.  Fortunately,  I  was  never  urged  to  accompanj'  them.  I 
like  female  societ}^  and  I  have  often  been  envied  for  being  so  fortunate. 
I  can  discover  no  special  inclination  in  myself  for  feminine  work,  though 
I  am  considered  a  judge  of  feminine  toilettes.  I  have  always  liked  to 
dance,  and  I  never  cared  whether  the  girl  with  whom  I  danced  was 
pretty  or  not,  as  long  as  she  danced  well. 

"  From  every  sport  of  male  youth  I  was  kept  by  the  anxious  care 
of  my  parents  or  the  family  physician,  in  order  to  keep  me  from  over- 
exertion.  When  I  had  once  passed  the  time  of  danger,  and  I  could 
have  devoted  myself  to  rowing,  etc.,  business  did  not  allow  me  the 
necessary  time.  Naturally,  my  whole  constitution  is  none  too  strong. 
Munich,  October  21,  1890." 

Treatment. — At  the  wish  of  the  patient  and  his  relatives,  I  under- 
took, with  the  help  of  hypnotic  suggestion,  to  free  him  from  his  patho- 
logical feelings.  I  felt  myself  justified  in  giving  a  relatively  favorable 
prognosis,  in  case  the  patient  would  submit  systematically  to  a  course 
of  treatment  that  would  be  wearisome  and  require  much  time.  In  this 
case  the  principal  aims  of  treatment  seemed  to  me  to  be  the  following: 
1.  To  combat  homo-sexual  feelings.  2.  To  induce  hetero-sexual  feelings. 
3.  To  bring  about  a  lasting  systematic  hetero-sexual  relation.  4.  To 
bring  about  engagement  and  marriage ;  that  is,  to  insure  him  against 
relapse  by  placing  him  under  appropriate  external  conditions.  Another 
part  of  the  task  was  to  overcome  the  neurasthenic  troubles. 

October  20, 1890.  First  attempt  at  hypnosis  by  Bernheim's  method. 
In  scarcely  two  minutes  H.  became  somnolent ;  complete  hypotaxis. 

18 


274  SEXUAL    PAR^ESTHESIA. 

Suggestive  catalepsy  and  suggestive  contracture.  Analgesia.  Sugges- 
tions :  (a)  indifference  to  men  ;  (6)  gradual  awakening  of  interest  in 
women  ;  (c)  physical  well-being. 

After  waking,  feeling  perfectly  well ;  pleasant  mood  ;  no  amnesia. 

October  21st.  Patient  comes  with  headache.  Repetition  of  the 
procedure  and  the  suggestions  of  yesterday  ;  besides,  removal  of  head- 
ache by  suggestion.  Again  hypotaxis.  No  headache  after  awaking. 

October  22d.  The  patient  reports  that  lie  feels  more  capable  of  re- 
sistance and  less  helpless  toward  men ;  besides  that  lie  notices,  to  his 
astonishment,  an  interest  in  women,  though  it  is  only  mental. 

Ou  October  23d,  24th,  and  25th,  repetition  of  the  same  suggestions. 

October  26th.  For  the  coming  night  an  erotic  dream  of  women  is 
suggested. 

October  27th.  The  patient  reports  joyfully  that  the  dream  was  ful- 
filled, and  that  in  the  dream  he  experienced  a  sexual  inclination  toward 
women,  connected  with  lustful  feelings. 

On  October  28th  and  29th,  besides  the  suggestions  of  October 
20th,  the  awakening  of  sexual  feelings  at  the  sight  of  women  is  sug- 
gested for  the  28th,  and  an  attempt  at  coitus  and  success  in  it  for 
the  29th. 

October  30th.  On  October  28th  horror  feminae  was  still  so  great 
that  he  had  nausea  when  about  to  visit  a  brothel  with  his  brother. 
He  could  not  conquer  himself,  and  turned  back.  On  October  29th, 
after  energetic  repetition  of  the  previous  suggestions,  the  patient  was 
able,  in  spite  of  great  excitement,  to  visit  a  brothel.  The  first  meet- 
ing with  a  woman  was  without  success.  Nausea;  intense  repugnance; 
impossibility  of  erection  in  spite  of  mechanical  stimulation  of  the  organ 
by  manipulations.  Patient,  who  is  much  depressed  by  his  failure,  is 
quieted  by  suggestion.  Suggestive  treatment  as  on  the  20th. 

October  31st.  In  hypnosis,  removal  by  suggestion  of  dull  head, 
want  of  appetite,  and  nausea.  Repetition  of  the  usual  procedure. 

November  1st.  The  patient  reports  that  inwardly  he  feels  as  if 
"  cut  off"  from  the  male  sex  ;  he  feels  the  loss  of  something.  Treatment 
as  usual. 

November  3d.  Prepared  by  suggestion,  H.  visits  a  prostitute  to- 
day. In  spite  of  energetic  stimulation  by  manipulation  and  the  help  of 
imagination  (thought  of  male  forms),  erection  was  impossible;  complete 
failure.  Sexual  desire  of  both  kinds  seems  to  be  destroyed. 

On  November  4th,  5th,  6th,  7th,  and  8th,  in  spite  of  the  want  of 
success  thus  far,  success  in  coitus,  in  connection  with  the  usual  sugges- 
tions, is  daily  suggested.  On  the  night  of  November  4th,  lascivious 
dream  of  male  forms  without  pollution.  On  the  7th  and  8th  H.  visited 
a  dance-hall,  without,  however,  taking  one  of  the  girls. 

November  8th.  A  new  attempt  in  a  brothel  for  the  8th  or  9th  is 


CONTRARY   SEXUAL   INSTINCT.  275 

suggested ;  and  quiet,  power  to  overcome  shyness,  and  complete  success 
are  always  suggested.  Suggestion :  "  Erection,  to  your  astonishment 
and  without  any  act  on  your  part,  will  suddenly  occur." 

The  patient  states  that  November  9th  was  the  most  terrible  day  of 
his  treatment.  On  the  morning  of  this  Sunday  he  found  himself  excited. 
Great  depression.  Thoughts  of  suicide.  He  thinks  his  life  a  failure.  He 
thinks  himself  impotent,  the  more  because  after  three  weeks  of  treatment 
there  is  no  noticeable  progress.  On  the  night  of  the  8th  he  had  not  the 
courage  to  carry  out  the  plan.  In  order  to  weaken  to  some  extent  the 
opposing  ideas  and  feelings,  this  evening  H.  prepared  himself  by  taking 
alcohol  (beer,  etc.),  and  about  10  o'clock  he  repaired  to  the  brothel. 
After  he  had  been  with  the  puella  alone  for  about  twenty  minutes  with- 
out the  occurrence  of  erection  with  the  help  of  manipulations,  to  the 
patient's  astonishment,  erection  occurred  spontaneously.  Coitus  was 
performed  with  lustful  pleasure.  Of  course,  the  latter  was  not  to  be 
compared  in  intensity  with  that  of  male  intercourse;  but  H.  is  delighted 
by  his  success,  and  finds  pleasure  in  hetero-sexual  congress. 

On  November  10th,  llth,  and  12th  the  treatment  was  continued 
with  the  earlier  suggestions. 

On  the  night  of  November  llth  the  patient  dreamed  he  was  in  a 
brothel,  had  a  powerful  erection  (actual),  and  attempted  coitus,  but  was 
always  kept  from  it  by  external  circumstances  (noise,  slamming  of  doors, 
etc.),  which  made  him  very  angry. 

November  12th.  Suggestions  :  Performance  of  coitus  to-day ;  in- 
creasing hetero-sexual  libido  ;  intense  lustful  feeling. 

November  13th.  Last  night,  without  preparation  by  alcohol,  the 
patient  performed  coitus  ;  spontaneous  erection  ;  more  intense  lustful 
feeling. 

On  the  9th  and  13th  the  victory  over  the  patient's  homo-sexual 
feeling  was  decided  ;  the  most  difficult  part  of  the  task,  namely,  the 
induction  of  hetero-sexual  feeling,  was  performed.  With  this  the  patient 
passes  into  the  stage  of  psychical  hermuphroditism  ;  the  promotion  and 
fixation  of  the  hetero-sexual  way  of  feeling,  which,  in  comparison  with 
the  natural  inversion  of  patient,  is  still  weak,  form  the  second  object. 
Strengthening  of  his  feelings  by  suggestive  influence  and  systematic 
hetero-sexual  congress  should  be  continued  till  the  predominance  of 
normal  sexual  feeling  is  complete,  and  can  no  longer  be  touched  b}'  even 
intense  homo-sexual  stimulus.  The  patient  is  now  treated  with  hypnotic 
suggestions  in  the  manner  outlined ;  as  a  rule,  he  passes  only  into  the 
stage  of  hypotaxis,  never  into  somnambulism. 

November  16th  and  19th,  successful  coitus. 

November  22d.  Coitus  does  not  succeed,  in  spite  of  all  efforts  ;  but 
during  the  attempt  violent  headache  occurs,  which  continues  to  the 
24th,  and  is  removed  by  suggestion. 


276  SEXUAL    PAR^STHESIA. 

November  24th.  Repetition  of  sexual  congress,  as  a  result  of  sug- 
gestion. The  first  attempt  on  this  evening  is  a  failure,  the  second  a 
success. 

November  26th.  Coitus  successful,  but  immediately  after  it  nausea 
and  tendency  to  syncope.  The  patient  still  has  erections  at  the  sight 
of  powerful  men,  but  much  less  frequently,  and  only  episodically. 
Every  instance  of  this  kind  is  conscientiously  confessed. 

November  30th.  Premature  ejaculation  with  insufficient  erection. 
Depression. 

December  2d.  The  same  as  on  November  30th. 

December  6th.  Complete  success  in  the  sexual  act. 

December  10th.  Coitus  successful;  slow  progress.  There  is  still 
always  a  certain  inclination  toward  the  male  sex. 

December  15th.  To-day  the  patient  is  very  well  satisfied  with  the 
success  of  his  sexual  congress  with  a  prostitute  yesterday. 

December  22d.  Congress  with  a  very  passionate  woman.  Good 
success.  But  the  patient  prefers  women  of  a  quiet  temperament. 
In  the  hypnotic  sittings  during  December  it  is  daily  suggested  to  the 
patient  that  he  become  engaged  to  a  grand  and  attractive  young  lady. 
This  marriage  is  the  secret  wish  of  both  families.  The  patient  left  on 
December  22d,  to  be  absent  several  weeks,  with  the  intention  to  become 
engaged  immediately. 

The  results  of  the  fifty-two  suggestions  are:  (a)  the  establishment 
of  a  regulated  hetero-sexual  relation  based  on  artificially  induced  feel- 
ings ;  (b)  the  progressive  diminution  of  homo-sexual  feelings;  (c)  the 
removel  of  former  physical  troubles ;  (d)  the  determination  to  become 
engaged.  Several  days  before  the  patient's  departure  I  requested  him 
to  give  me  a  written  statement  of  the  changes  that  had  taken  place  in 
him.  This  important  addition  to  my  observations  follows. 

Report  of  the  Patient  on  the  Course  of  Treatment,  December  17, 
1890. — "  After  having  been  under  Dr.  Schrenck's  treatment  for  two 
months,  I  may  report  as  follows  concerning  the  result : — 

u  Led  by  constantly  repeated  and  appropriate  suggestion,  I  over- 
came my  repugnance  for  sexual  congress  with  women  so  that  I  under- 
took to  indulge  in  regulated  intercourse.  I  progressed  gradually  until, 
as  a  result  of  habit  and  a  slowly  progressing,  but  unmistakable,  change 
of  feeling,  the  act  of  coition  was  more  and  more  perfectly  performed. 
Simultaneously  with  this  change  1  felt  a  barrier  raised  between  my 
present  and  my  former  life.  I  have  the  sure  hope  that  my  love  of  men 
will  grow  less  and  less,  and  that  I  shall  soon  be  free  from  it. 

"  Formerly  I  felt  an  actual  repugnance  for  sexual  congress  with  a 
woman  ;  I  thought  it  impossible  for  me  to  perform  this  sexual  act. 
Without  suggestion  I  should  never  have  had  the  courage  to  approach  a 
woman.  No  wonder  that  the  first  attempts  in  obedience  to  suggestion 


CONTRARY   SEXUAL   INSTINCT.  277 

were  not  successful  (want  of  erection)  and  thaf  I  was  nauseated.  Be- 
sides I  also  was  depressed  and  melancholic,  and  had  suicidal  thoughts. 
I  thought  my  life  a  failure,  and  was  very  unhappy.  First,  the  suggestive 
treatment  was  successful  in  overcoming  the  terrible  excitement  which 
came  on  me  whenever  I  attempted  to  perform  the  act,  as  well"  as  the 
feeling  of  repugnance  and  nausea.  As  if  following  an  inner  impulse, 
and  without  its  costing  any  effort  of  late,  I  have  made  two  attempts  at 
intercourse  weekly.  While  at  first  erection  was  entirely  wanting,  or 
occurred  only  after  manipulation,  later  it  occurred  spontaneously  as  a 
product  of  sensual  excitement.  And  while  at  first  sexual  congress  gave 
me  but  slight  pleasure,  during  the  later  weeks  lustful  feelings  and  gen- 
eral sexual  excitement  became  so  intense  that  I  think  I  reached  the 
acme  of  physical  pleasure  possible  for  a  normal  man  ;  at  least,  as  far  as 
it  is  possible,  without  aesthetic  basis,  with  a  prostitute.  My  depressed 
moods  have  entirely  disappeared  ;  I  am  hopeful  of  the  future,  and  I  now 
think  myself  capable  of  all  there  is  demanded  of  a  man.  I  am,  there- 
fore, determined  to  become  engaged  in  a  few  weeks. 

"  As  far  as  my  inclinations  toward  men  are  concerned,  I  have 
neither  a  tendency  to  lascivious  dreams  nor  to  onanism.  While  before 
the  treatment  they  came  to  me,  since  the  first  day  of  treatment  I  have 
had  nothing  to  complain  of  in  that  respect.  My  previous  intense  ex- 
citability to  men  has  given  place  to  a  degree  of  indifference  and  power 
of  resistance  which  formerly  seemed  impossible  to  me,  and  which  seemed 
to  increase  with  the  feeling  of  satisfaction  in  hetero-sexual  congress. 
Still,  I  am  not  free  from  such  tendencies;  for  a  few  weeks  ago,  to  my 
astonishment,  I  discovered  myself  with  an  erection  at  the  sight  of  an 
attractive  man.  On  the  whole,  however,  an  inner  transformation  has 
taken  place  in  me  ;  and  I  am  fully  convinced  that  in  the  I'egulated  sexual 
relations  of  marriage  the  last  remnants  of  my  fatal  malady  will  be 
eradicated. 

"  As  for  the  suggestive  treatment  in  other  respects,  I  can  only 
assert  that  upon  other  temporary  physical  ailments  (feeling  of  nausea, 
headache)  it  alwa}'s  had  a  sure  effect.  I  always  felt  very  well  after  hyp- 
nosis ;  my  general  feeling,  mood,  etc.,  have  improved  as  far  as  it  was 
possible  for  them  to  improve.  Munich  December  17,  1890." 

During  the  course  of  treatment  the  neurasthenic  complaints,  which 
to  a  certain  extent  depended  upon  the  sexual  condition  of  the  patient, 
diminished.  Dietetic  rules,  regulation  of  occupation,  and  cold  rubbing 
completed  the  physical  treatment  of  the  patient.  In  avoiding  over- 
exertion  and  excesses,  such  as  was  practiced  by  him,  against  medical 
advice,  during  the  carnival,  the  patient  kept  well.  Headache,  rheu- 
matic symptoms,  and  feelings  of  dizziness  were  always  removed  by  sug- 
gestion when  other  means  were,  ineffectual.  During  the  course  of  treat- 
ment the  patient  became  able  to  resume  his  business ;  physical  complaints 


278  SEXUAL    PAR^ESTHESIA. 

became  less  frequent ;  and  though  symptoms  now  sometimes  occur  (end 
of  Ma}^),  they  are  always  due  to  overexertion  in  business.  Sometimes 
the  patient  is  kept  on  his  feet  all  day. 

New  Year's,  1891,  I  was  pleased  to  learn  of  H.'s  engagement.  His 
letter  ran  as  follows  : — 

"January  2, 1891.  Dear  Doctor:  I  have  the  pleasure  to  inform  you 
of  my  engagement,  though,  owing  to  my  fiancee's  youth,  it  has  not  yet 
been  announced.  I  joyfully  hope  that  this  marriage  will  bring  me  com- 
plete happiness,  and  that,  in  a  way,  it  may  be  regarded  as  a  conclusion 
of  your  treatment ;  for,  in  marriage,  the  last  traces  of  my  malady  will 
certainly  disappear. 

"  That  I  am  able  to  enjoy  the  happiness  of  marriage  I  owe  to  you, 
and  I  shall  never  forget  it. 

"  Always  gratefully,  H." 

At  my  request  the  patient  enlarged  his  letter  by  sending  me  the 
following  report : — 

"  The  feelings  which  attach  me  to  my  fiancee  are  of  an  entirely  dif- 
ferent nature — deeper  and  purer — from  those  feelings  which  were  for- 
merly excited  in  me  by  persons  of  my  own  sex.  I  think  I  shall  find  a 
happiness  which  before  seemed  impossible,  and  which  I  have  never  known 
before.  Too,  the  inner  bond  that  holds  me  differs  from  the  relations  of  a 
more  sexual  nature  that  thus  far  I  have  had  with  females  as  a  result  of  sug- 
gestion, in  that  I  now  feel  entirely  satisfied  aesthetically  ;  and  thus  a  pre- 
vious want  has  been  supplied.  I  think  it  impossible  that  impulses  like  the 
former  ones  will  ever  gain  the  upper  hand.  I  feel  cold  indifference  for 
the  male  sex.  1  think  I  am  cured;  and  it  only  remains  to  make  the 
present  undoubted  result  permanent,  in  order  to  lay  the  foundation  of 
my  life's  happiness.  Formerly,  I  should  never  have  thought  this  trans- 
formation possible,  and  I  never  should  have  been  strong  enough  to  part 
so  completely  with  the  past.  I  also  think  it  would  have  been  impossible 
to  have  produced  such  a  result  by  merely  moral  treatment  in  the  waking 
state.  All  efforts  of  this  kind,  all  ideas,  either  from  others  or  myself, 
were  absolutely  powerless  against  m}'  impulse.  This  brilliant  result,  in 
my  opinion,  is  only  to  be  ascribed  to  continuous  treatment  with  hypnotic 
suggestion.  I  owe  to  you  and  to  it  the  happiness  of  my  life,  and  I  close 
with  the  wish  that  many  others  may  be  helped  as  I  have  been,  by  the 
same  means." 

In  order  to  fully  develop  the  patient's  hetero-sexual  instinct,  and 
to  make  it  permanent,  after  his  return,  H.  was  treated  in  the  months  of 
January  and  February,  and  until  March  10,  1891,  with  hypnotic  sittings 
almost  daily.  During  this  period  he  performed  coitus  about  thrice  a 
week  as  directed.  In  spite  of  slight  episodical  variations  in  mental 
equilibrium,  the  hetero-sexual  development  slowly  progressed.  Pause 
in  the  treatment  from  January  17th  to  28th  on  account  of  catarrh. 


CONTRARY   SEXUAL   INSTINCT.  279 

As  my  note-book  shows,  the  patient  performed  coitus  on  January 
7th,  10th,  14th,  17th,  28th,  31st;  on  February  3d,  6th,  (12th),  13th,  16th, 
21st,  26th,  28th;  on  March  3d,  6th,  9th,  15th,  18th,  22d,  25th  (29th), 
and  during  April  and  May  usually  twice  a  week. 

On  February  12th  and  March  29th  the  attempts  at  coitus  were 
failures  ;  possibly  because  the  patient  felt  very  weary  physically,  for  the 
better  he  feels  physically  the  more  easily  he  can  perform  coitus.  On 
some  days  erection  occurred  only  after  mechanical  stimulation  by  manip- 
ulation ;  sometimes  ejaculation  was  tardy.  Gradually  a  need  was  devel- 
oped for  normal  indulgence.  The  intensity  of  lustful  feeling  increased 
so  that  on  one  occasion  he  performed  the  act  twice  in  succession.  After 
the  act  there  was  great  physical  buoyancy,  as  well  as  quiet,  dreamless 
sleep.  During  the  days  following  it,  no  sexual  desire,  feeling  of  perfect 
health,  inner  satisfaction,  and  want  of  reaction  to  homo-sexual  charms. 
Since  March  10th  the  patient  has  been  employed  in  Munich,  working 
hard  in  an  office  from  morning  till  evening.  Sometimes  he  is  greatly  ex- 
hausted in  the  sexual  act  at  night  on  account  of  his  hard  work  during 
the  day.  After  that  date  I  hypnotized  him  only  once  every  week  or  two. 
At  the  end  of  May  H.  had  had  one  hundred  and  fourteen  sittings.  As 
long  as  H.  has  normal  congress  with  automatic  regularity  twice  a  week, 
he  feels  happy  and  like  a  healthy  man,  and  is  not  reminded  of  his  con- 
trary natural  disposition.  If  this  condition  become  stable,  which,  after 
marriage,  it  probabty  will  do.  the  patient  may  then  be  regarded  as  rela- 
tively cured.  If,  owing  to  circumstances,  pauses  in  sexual  indulgence 
of  a  week  or  longer  occur,  sexual  impulses  for  men  episodically  appear. 

Thus,  on  May  16th,  the  patient  reported  that  at  the  end  of  the 
week,  after  a  pause  of  eight  days,  homo-sexual  impulses  occurred  in  a 
way  painful  to  him,  in  the  form  of  an  erection  at  the  sight  of  a  male 
associate. 

During  the  night  following  this  he  dreamed  that  a  man  sought  to 
force  him  to  homo-sexual  congress  against  his  will  and  in  spite  of  violent 
resistance.  He  experienced  an  intense  feeling  of  disgust  and  repugnance 
for  this  kind  of  indulgence.  In  spite  of  his  resistance  the  man  suc- 
ceeded in  embracing  him,  but  without  touching  his  genitals.  This 
dream  was  sufficient  to  induce  pollution.  The  next  morning  there 
was  great  moral  distress.  The  same  day  the  patient  visited  a  prostitute, 
and  performed  coitus  twice  to  restore  his  peace  of  mind,  and  was  thus 
successful. 

Moreover,  this  psycho-sexual  relapse,  if  it  may  be  called  such,  for 
which  he  blames  himself,  is  the  only  one  in  the  last  four  months.  It 
clearly  illustrates  the  necessity  of  systematic  sexual  congress.  But  it 
also  shows,  in  the  resistance  of  the  dream,  the  association,  artificially 
created  by  suggestion  and  sexual  intercourse,  seeks  to  declare  its  inde- 
pendence in  the  struggle  against  the  homo-sexual  memory-pictures,  still 


280  SEXUAL    PAR^STHESIA. 

relatively  the  stronger,  which  arose  from  the  natural  disposition,  and 
were  strengthened  by  habit.  With  the  further  development  of  the  new 
hetero-sexual  impulse,  the  patient's  improvement  progresses  step  by 
step;  but  the  development  depends  entirely  upon  the  nutriment  afforded 
by  the  original  cerebral  condition.  Sense-perceptions,  ideas,  and  activity 
of  the  imagination  must  be  made  to  influence  the  lustful  feeling  as  much 
as  possible.  This  hetero-sexual  mechanism  must  be  kept  in  systematic 
activity,  if  the  impulse  is  to  become  strong  enough  to  obviate  the  op- 
posing ideas  of  an  homo-sexual  nature,  which  are  constitutionally 
conditioned  (?),  and  manifest  themselves  imperatively. 

If,  in  this  stage  of  psycho-sexual  hermaphroditism,  the  increase  of 
libido  in  relation  to  females  signify  a  decided  diminution  of  homo-sexual 
feeling,  then  it  must  be  the  object  of  the  patient  and  physician  to  avoid 
most  carefully  every  stimulus  to  contrary  sexual  feeling  (cessation  of 
intercourse  with  males,  etc.),  in  order  that  atrophy  from  inactivity  may 
take  place  in  time.  As  soon  as  it  has  shrunken  in  this  way,  for  want  of 
exercise,  to  a  rudiment  which  is  noticeable  only  occasionally,  but  no 
longer  gives  rise  to  disturbance  or  is  felt  as  abnormal,  the  product  of 
artificial  cultivation  has  compensated  the  natural  fault.  This  condition 
may  be  regarded  as  a  relative  cure. 

Conclusion. — During  the  months  of  July  and  August,  1891,  it  was 
necessary  to  discontinue  treatment.  During  July  the  patient  was  kept 
in  bed  several  weeks  by  an  intestinal  malady,  and  this  caused  a  longer 
interruption  of  sexual  indulgence.  On  this  occasion  ejaculation  occurred 
twice  spontaneously  when  a  sympathetic  friend  was  feeling  his  pulse. 
Sexual  hyperaesthesia,  due  to  abstinence  ;  faute  de  mieux,  the  unsatisfied 
impulse  took  its  old  direction.  The  patient  was  very  unhappy  about 
this,  and  lost  all  hope  of  cure.  September  12th  the  treatment  was  re- 
sumed, and  bromides  were  simultaneously  used  for  some  weeks.  From 
that  time  H.  was  treated  in  ninety  sittings  (two  hundred  and  four  in 
all) ;  and  at  the  present  time  he  is  hypnotized  once  a  week  at  his  desire 
as  a  prophylactic.  For  several  months  his  sexual  life  has  been  entirely 
regular.  Coitus  once  or  twice  a  week ;  no  homo-sexual  impulse  has  been 
manifested  in  that  time.  At  the  beginning  of  this  period  erections  oc- 
curred irregularly,  but  they  gradually  came  spontaneously  and  promptly, 
with  hetero-sexual  thoughts  as  well  as  in  sexual  congress.  His  interest 
is  entirely  directed  to  women ;  indeed,  he  has  developed  a  distinct  taste, 
and  likes  to  change  the  object  of  his  attentions  from  time  to  time.  Now, 
as  formerly,  he  is  in  active  correspondence  with  his  fiancee,  and  is 
attracted  to  her  by  real  love. 

Since  in  the  last  seven  months  the  former  perversion  of  desire  has 
not  expressed  itself  in  an}'  way,  and  whereas  the  sexual  life  is  fully 
regulated,  the  patient  may  be  regarded  as  cured.  The  time  of  observa- 
tion was  one  year  and  five  months. 


CONTRARY   SEXUAL   INSTINCT.  281 

Case  67.  Personal  Observation.  Active  Contrary  Sexual  Instinct 
with  Imperative  Ideas,  Dependent  on  Neuropathic  Predisposition ;  Ex- 
hibition, Algolagny,  and  Impulsive  Onanism.  Essentially  Improved  in 
Twenty  Sittings.  Period  of  Observation,  Two  Months. — J.,  aged  27  ; 
scholar.  Mother  has  religious  insanity  (in  asylum)  ;  father  health}'.  Of 
eight  children,  two  died  soon  after  birth  ;  one  brother  died  by  suicide  in 
his  sixteenth  year,  another  is  shy  and  mood}'.  The  sixth  brother  is 
weak-minded  ;  the  seventh  is  married,  father  of  a  family,  and  healthy. 
In  the  family  of  the  patient's  father  there  is  said  to  have  been  weak- 
minded  members.  The  average  intelligence  of  ancestors  on  the  mother's 
side  is  said  to  be  higher  than  on  the  father's  side. 

In  his  youth  the  patient  had  measles,  but  no  other  diseases.  Right 
inguinal  hernia.  The  patient  describes  his  first  sexual  manifestations  as 
follows  : — 

"I  have  no  recollection  of  any  sexual  excitement  before  my  thir- 
teenth year;  my  sexual  desire  lay  completely  dormant,  though,  from 
expressions  of  my  companions  and  certain  passages  in  the  Old  Testa- 
ment, I  knew  quite  fully  the  nature  of  coitus ;  but  of  ejaculation  I 
knew  nothing.  Otherwise  it  should  be  noted  that  I  was  very  precocious 
mentally,  but  very  weak  physically,  and  read  everything  at  the  age  of  9; 
so  that  books  were  kept  away  from  me.  Until  my  ninth  }7ear  I  was  irri- 
table, peevish,  and  a  perfect  recluse.  From  that  time,  with  more  rapid 
physical  development,  I  gradually  developed  a  taste  for  boys'  play,  and 
soon  I  became  the  leader  in  all  mischief — what  my  aunts  called  a  bad  bo}7. 

"  At  the  age  of  14,  in  climbing,  by  pressure  of  the  thighs,  I  learned 
onanism,  and  I  have  since  then  practiced  it  until  a  week  ago, — now  fre- 
quently, now  seldom.  The  sight  of  semen  completed  my  knowledge  of 
the  sexual  process,  and  my  imagination  was  often  busy  with  thoughts  of 
coitus  ;  and  from  the  beginning  only  the  role  of  the  man  interested  me. 
Here  I  must  remark  that  from  the. day  of  my  entrance  into  the  Latin 
school  handsome  fellow-pupils  attracted  me  ;  and  I  entered  into  closer 
friendship  with  them  than  with  others  by  preference,  provided  that  their 
character  was  pleasing  to  me.  And  even  yet  handsome  men  can  interest 
me  for  long  only  when  their  character  is  sympathetic  for  me;  otherwise 
sensual  excitement  caused  by  the  handsomest  man  is  immediately  ex- 
tinguished. 

"  Now  dreams  of  large,  handsome  men  began ;  and  I  loved  to 
follow  such  persons  in  the  street,  to  be  able  to  look  at  them  as  long  as 
possible.  If  such  a  man  spoke  to  me,  blackness  came  before  my  eyes 
and  I  returned  shy  and  foolish  answers.  At  that  time  it  was  m}7  greatest 
enjoyment  to  see  a  man  naked  or  in  the  act  of  coitus.  When  my  com- 
panions began  to  court  the  school-girls,  it  seemed  to  me  strange  and 
tiresome;  but,  since  it  was  the  fashion,  I  also  once  undertook  it;  but 
when  I  once  realized  that  I  knew  not  in  the  least  how  to  proceed,  I  was 


282  SEXUAL    PAILESTHESIA. 

greatly  frightened.  Besides,  in  spite  of  onanism  and  dreams  with  pol- 
lutions, I  was  not  much  influenced  by  sexual  feelings,  and  therefore 
continued  to  be  the  best  scholar  in  the  class  until  I  reached  the  second 
form.  I  was  loved  by  my  fellow-students  ;  always  ready  for  mischief  and 
nonsense." 

The  patient's  autobiography,  which  I  here  interrupt,  gave  me  but 
an  unsatisfactory  explanation  of  the  origin  of  his  homo-sexuality ;  from 
this  description  and  its  continuation,  one  might  be  tempted  to  believe  in 
the  original  cerebral  constitution,  in  a  greatly-tainted  individual,  as  being 
the  cause  of  the  contrary  sexual  instinct.  Repeated  careful  questioning, 
after  three  days,  led  to  the  result  that  several  other  accidental  influences, 
which  he  had  regarded  as  of  little  moment,  occurred  to  him,  and  gave  me 
the  key  to  a  psychological  understanding  of  his  case. 

At  the  age  of  4  or  5  the  patient  once  went  walking  with  his 
father.  The  father  drew  near  to  a  tree  to  urinate,  and  with  childish 
astonishment  the  boy  looked  at  his  father's  penis.  A  sounding  box  on 
the  ear  disturbed  his  spying.  He  was  not  conscious  of  doing  any- 
thing wrong,  and  for  years  he  was  busy  with  the  thought  of  why  he 
should  have  had  this  punishment.  His  interest  in  the  male  genitals, 
which  seemed  to  him  forbidden  fruit,  was  artificially  first  aroused  by 
the  punishment.  As  soon  as  he  had  opportunity,  he  looked  at  male 
genitals,  which,  since  the  box  on  his  ear,  had  played  an  important  part 
in  his  imagination.  He  remembered  regarding  the  picture  of  "  Apollo 
pursuing  Daphne"  in  a  gallery,  because  Apollo  was  figured  with  an 
erected  penis.  Prom  the  original  interest  in  male  genitals  there  was 
secondarily  developed  an  interest  in  male  nudity,  statues,  etc.  The  fol- 
lowing important  event,  and  which  was  also  later  recalled,  completes 
the  etiology  of  the  patient's  sexual  perversion.  At  the  time  of  his  first 
onanistic  manipulations,  in  his  thirteenth  year,  he  slept  in  a  room  with 
a  friend.  The  desire  to  see  male  genitals  was  shown  in  the  case  of  this 
companion,  and  the  patient's  rest  was  disturbed  by  it.  At  4  in  the 
morning,  while  his  room-mate  was  still  in  deep  sleep,  the  patient  got  up, 
approached  his  bed,  and  lightly  raised  the  covers  and  his  friend's  shirt. 
In  great  sexual  excitement  he  looked  at  his  genitals.  Then  he  returned 
to  bed  and  masturbated  while  his  imagination  was  busy  with  the  image 
of  his  naked  companion  and  his  genitals.  He  thought  of  how  his  friend 
might  perform  coitus,  without  thinking  of  the  part  of  the  female. 

As  we  see,  external  circumstances  of  intense  effect  on  a 
childish  mind  induced  the  lively  fancy  of  the  male  member, 
which,  by  further  experience  and  accompanying  onanistic  acts, 
finally  become  imperative.  All  other  symptoms  which  com- 
pleted the  condition  of  contrary  sexuality  are  of  a  secondary 


CONTRARY   SEXUAL   INSTINCT.  283 

nature.  The  hereditary  taint  explains  the  intense  excitability 
of  the  patient,  and  his  final  inability  to  resist  the  manifestations 
which  were  developed  from  the  experiences  enumerated.  The 
unditferentiated  sexual  feeling,  therefore,  was  made  pathological 
and  inverted  by  accidental  influences  and  the  accompanying 
reflex  effect  of  onanistic  habits.  But  the  autobiographical  state- 
ments of  the  patient  are  so  made  that  from  them  alone  one 
would  be  forced  to  regard  his  abnormality  as  congenital ;  the 
more  because  the  patient  wrote  them  while  still  under  the  in- 
fluence of  reading  von  Krafft-Ebing's  "  Psychopathia  Sexualis." 
After  this  digression,  necessary  for  an  understanding  of  this 
case,  and  so  instructive  in  its  bearing  upon  the  examination  of 
urnings,  we  may  return  to  the  history  of  the  case.  In  his  auto- 
biography the  patient  continues: — 

"  While  I  was  not  yet  17  two,  friends  persuaded  me  to  take  a  trip 
to  M.,  where  the  nearest  brothel  was.  I  had  not  the  slightest  desire  for 
the  thing ;  but  I  went  to  avoid  hanging  back.  Before  going  I  drank  to 
gain  courage.  The  woman  excited  my  repugnance  by  her  hanging 
breasts.  I  had  no  erection  at  all,  and  only  after  prolonged  manipulation 
by  the  woman  was  I  able  to  perform  coitus,  and  that  without  the  slightest 
feeling  of  pleasure  After  the  act  I  slipped  away  ;  and  while  the  others 
could  not  say  enough  in  describing  the  pleasure  they  had  had,  I  remained 
silent,  irritable,  and  ashamed.  I  now  thought  myself  impotent  as  a 
result  of  my  onanism,  and  I  sought  to  repair  this  defect  by  temporary 
abstinence;  but  renewed  attempts  resulted  in  similar  fiascoes,  and  in 
despair  I  returned  to  onanism.  Continued  onanistic  excitement  grad- 
ually induced  a  weakness  of  my  mental  powers  and  my  energy.  I  could 
no  longer  take  the  first  place.  'The  teacher  reproached  me  with  want  of 
ambition,  and,  since  I  was  threatened  with  imprisonment  and  the  can- 
silium  abeundi  for  joining  a  student  society  and  for  taking  part  in 
various  drinking  pai'ties,  my  place  in  the  esteem  of  the  teachers  was  lost. 
Still,  in  mathematics,  in  which  I  was  about  the  best,  I  always  took  one 
of  the  first  places,  and  I  passed  a  respectable  final  examination.  In  the 
fall  of  1885  I  went  to  the  university.  Here,  during  the  first  years,  I  led 
a  pleasant  life.  Now  and  then  I  visited  prostitutes,  but  always  with  the 
same  lack  of  success ;  so  that  at  last  I  abandoned  the  matter  entirely. 
Originally  light-hearted,  now  my  thoughts  began  to  be  directed  to  my 
peculiar  sexual  disposition,  for  in  time  it  struck  me  that  my  lascivious 
dreams  were  so  often  of  men  and  so  very  seldom  of  women,  and  that  in 
pictures  and  statues  male  nudity  excited  me,  while  female  nudity  left  me 
cold.  I  accidentally  read  the  statement  in  a  book  that,  aesthetically,  the 


284  SEXUAL    PAILESTHESIA. 

male  body,  and  especially  the  male  genitals,  were  more  beautiful  than  the 
female,  and  I  comforted  myself  with  the  thought  that  my  aesthetic  feeling 
was  finer  than  that  of  my  friends,  who  merely  ridiculed  me  for  my  asser- 
tion. In  the  same  way  I  explained  to  myself  the  fact  that  certain  ones  of 
my  friends  who  were  especially  handsome  and  well  formed,  and  of  amiable 
character  and  sympathetic,  gave  me,  at  the  merest  contact,  an  inexplicable 
feeling  of  pleasure  (no  erections, — of  which,  perhaps  as  a  result  of  long- 
continued  onanism,  I  was  incapable, — but  a  thrill  through  my  nerves). 
At  that  time,  in  my  innocent  and  happy  moods,  I  loved  to  place  my  arm 
around  my  friend's  neck  or  waist,  or  I  stroked  his  hair,  which  led  him  to 
joke  me  about  being  a  pederast.  When  it  was  said  "  G.  (my  name 
among  friends)  has  pederastic  inclinations  again,"  I  laughed  with  the 
rest,  and  was  not  in  the  least  irritated.  I  had  not  the  remotest  idea  that 
I  had  anything  in  common  with  pederasts,  who,  to  me,  were  a  kind  of 
fiction,  and  even  up  to  a  year  ago  I  joined  in  the  ridicule  about  the 
'  spinalstecher.''  I  had  a  repugnance  for  these  persons  ;  and  still  to-day, 
though  I  understand  my  condition,  I  cannot  free  myself  from  this  feel- 
ing ;  and  this  is  not  the  least  of  the  reasons  why  I  feel  my  perversion  as 
painful. 

"  I  now  come  to  the  last  and  most  important  phase  of  my  con- 
dition, in  that  it  finally  gave  me  the  desired  understanding  of  it;  it  took 
place  during  this  year.  One  after  another  of  my  friends  left  the  high- 
school,  to  my  great  distress,  for  I  am  dependent  on  them,  and  still  cor- 
respond with  them  all.  Only  one  remained,  the  one  I  loved  best,  my 
friend  A.,  who  has  obtained  a  situation  here.  He  is  a  thick-set,  strongly- 
built  man,  with  a  remarkably  handsome  face  of  pure  German  type,  and  a 
complexion  uniformly  ruddy  and  healthy  ;  his  temperament  is  joyous 
and  sunny,  and  he  is  an  example  of  truthfulness  and  frankness,  with 
a  determined,  manly  bearing, — all  characteristics  which  irresistibly 
attract  me. 

"  We  were  always  on  the  best  of  terms,  and  now  when  we  were 
thrown  so  much  together  we  became  more  closely  attached  to  each 
other.  Last  winter  circumstances  made  it  necessary  for  him  to  live  in 
my  room  for  weeks  at  a  time.  After  a  week  I  could  not  live  without 
him.  At  6  in  the  evening  he  would  come  home,  where  I  awaited  him 
with  impatience.  At  8  or  9  or  10  o'clock  in  the  evening  we  were  ac- 
customed to  go  out;  until  that  time  he  worked  and  I  studied  or  read. 
If  he  had  had  enough  work  he  would  stretch  out  on  the  sofa,  and  I  then 
always  felt  forced  to  look  at  his  genitals,  which,  owing  to  the  tight 
trousers  he  wore,  were  often  clearly  visible.  It  was  strange  that  for  a 
long  time  1  did  not  experience  this  degree  of  sensual  excitement  when  I 
saw  his  genitals  exposed,  as  I  often  did  ;  for  at  first,  in  his  innocence,  he 
made  no  attempt  to  conceal  them  while  dressing  and  undressing.  Since, 
in  his  jolly  way,  he  was  always  accustomed  to  joke,  one  evening  we  had 


CONTRARY    SEXUAL   INSTINCT.  285 

a  sham  fight.  He  bolted  away  and  threw  himself  on  my  bed  ;  I  followed 
him,  grabbed  him  by  the  neck,  and  choked  him  hard.  In  this  act  I  came 
on  top  of  him, — abdomen  to  abdomen, — and  suddenly  I  had  a  powerful 
erection,  which  was  quickly  followed  by  an  ejaculation.  I  had  never  felt 
such  intense  lustful  pleasure,  and  I  was  never  so  joyous  and  light-hearted 
as  when  we  went  out  to  a  restaurant  immediately  sifter.  From  this  time 
I  used  every  opportunity  to  strike  him  on  the  thighs  and  nates,  or  to 
stroke  his  hair;  but,  when  I  noticed  that  these  things  were  annoying 
to  him,  I  got  out  of  the  habit.  Evenings  I  began  to  set  him  on  for  a 
fight,  and,  since  he  was  much  stronger  than  I,  I  had  to  exert  myself,  and 
I  had  thus  an  excuse  for  hugging  him  tightly,  which  always  soon  induced 
ejaculation.  This  continued  for  eight  or  ten  evenings.  If  he  were  not 
disposed  to  tussle,  I  became  cross.  Otherwise  I  was  jolljr  and  much  more 
industrious  than  usual.  It  was  a  delight  to  me  to  live.  Then,  unfor- 
tunately, I  once  allowed  myself  to  grasp  his  genitals  while  embracing 
him.  How  I  came  to  do  it  I  do-  not  know ;  for,  with  the  exception  of 
this  one  instance,  I  have  never  in  my  whole  life  attempted  this  or  allowed 
it  done  to  me.  Now,  my  secret  joys  were  over.  He  became  angry  and 
scolded  me,  and  I  felt  as  if  I  had  been  given  a  sound  box  on  the  ear  for 
a  low  act.  In  a  state  of  the  most  terrible  depression  I  told  him  the 
whole  truth,  and  begged  him  to  believe  that  I  was  not  a  pederast,  and 
that  I  did  not  even  understand  myself.  As  well  as  he  could  he  com- 
forted me  and  advised  me  to  visit  a  girl,  but  I  did  not  do  it.  We 
remained  the  same  good  friends,  and  no  allusion  was  ever  made  to  the 
incident ;  indeed,  after  this  we  spoke  of  sexual  matters  only  with  reserve. 

"  But  his  innocent  manner  was  ended  ;  he  suffered  but  unwillingly 
even  the  most  innocent  touch,  and  he  was  anxiously  careful  to  conceal 
his  genitals  from  me.  But  in  this  waj'  he  only  increased  my  desire  to  see 
them  to  an  insane  longing.  When  at  night  I  lay  sleepless  in  bed  listen- 
ing to  his  breathing,  I  suffered  terribly.  Once  I  could  no  longer  restrain 
myself,  and  went  to  his  bed  to  touch  him.  But  while  standing  at  his 
bed,  trembling  and  panting  with  excitement,  the  former  scene  came  back 
to  me,  and  I  saw  that  I  was  about  to  commit  a  much  lower,  because 
a  secret,  act  on  him  while  sleeping,  and  that,  were  he  to  awake,  it 
would  cost  me  his  friendship  forever.  The  loss  of  his  respect  would 
have  cost  me  my  life.  I  quietly  went  back  to  my  bed. 

"  I  once  dared  him  to  undress  entirely  before  me.  Strange  to  sa}-;- 
I  had  never  seen  him  naked  (on  account  of  his  under-garments).  His 
answer  was  short  and  to  the  point :  '  I  do  not  respond  to  such  silly  dares.' 
And  he  was  right.  The  next  month  we  had  separate  rooms. 

"  The  last  }rear,  I  think,  has  done  more  to  destroy  m}'  nerves  than 
all  the  previous  ones  together.  At  least,  in  previous  years  I  was  spon- 
taneousl}7  light-hearted  ;  but  now  I  require  stimulants,  of  which  I  know 
two, — the  jollity  of  my  friend  and  alcoholics. 


286  SEXUAL    PAR^STHESIA. 

"  My  mood  was  that  of  a  wasted  existence.  Impulse  unsatisfied  ; 
great  moodiness.  No  man  ever  had  more  to  suffer  than  uiy  loved  friend 
had  in  my  whims.  I  suffered  unspeakably  with  this  unsatisfied  desire, 
and  was  petulant  in  his  presence.  And  yet,  in  quiet  moments,  I  had  to 
thank  him  for  his  reserve  and  strengthen  him  in  it.  But  this  did  not 
keep  me  from  at  last  becoming  jealous  when  he  for  a  long  time  became 
very  friendly  with  a  man  who  was  very  umittra&tive  to  me ;  and  I  could 
scarcely  meet  him  without  finding  the  hated  man  with  him.  I  should 
have  preferred  to  have  him  entirely  to  myself,  and  1  became  irritated 
when  he  spoke  of  other  friends  whom  I  had  never  seen  in  my  life.  On 
the  other  hand,  it  did  not  excite  me  in  the  least  when  he  went  to  have 
sexual  congress  or  to  court  a  girl ;  rather,  I  noticed  with  proud  joy  the 
advances  that  were  made  to  him  every  where,  and  where  possible  I  helped 
him  in  this.  All  my  unpleasant  moods  he  bore  with  great  patience,  and 
willingly  forgave  me  in  view  of  my  unlimited  sacrifice  and  friendship. 
Thus  we  parted  as  dearest  friends.  Had  I  discovered  any  unpleasant 
side  of  his  character, — critical  judgment  necessary  for  such  a  thing  was 
not  wanting  to  me  even  in  the  warmest  love, — my  sexual  feeling  for  him 
would  have  been  quickly  extinguished. 

"  But  my  love  for  him  became  more  and  more  ideal,  like  the  best 
type  of  friendship ;  and  I  thank  his  determined  energy  that  it  saved  my 
weak  will  from  the  greatest  errors. 

"  Accident  determined  that  on  the  day  following  his  departure  von 
Krafft-Ebing's  book  should  fall  into  my  hands.  Now  I  first  saw  clearly 
my  condition.  My  determination  was  soon  made.  I  congratulate  myself 
that  you  live  here  in  Munich,  Doctor.  I  feel  as  if  I  had  been  rescued 
from  an  abyss  ;  and  since  the  two  days  during  which  I  have  had  the 
honor  to  be  your  patient,  I  feel  free  from  sexual  desires  and  much  more 
light-hearted. 

"  After  this  general  description  of  my  sexual  development,  it  re- 
mains to  give  a  few  points  in  more  detail. 

"  1.  Sexual  Inclinations. — My  desires  are  never  directed  to  bojs  or 
young  persons,  but  always  to  men  from  28  to  50  years  of  age,  but  they 
must  have  .beards.  They  may  be  large  and  with  full  beards,  or  solidly 
built  and  with  moustaches.  In  general  I  prefer  blondes  (but  not  flax- 
blondes).  An  indispensable  condition,  however,  is  a  pleasant,  manly 
character.  Everything  feminine  is  unattractive  to  me. 

"  The  following  incident  may  be  considered  characteristic  of  this  : 
During  my  first  semester,  at  a  ball  I  made  the  acquaintance  of  a  gentle- 
man with  whom  (luring  the  evening  I  became  very  confiding.  During 
each  interval  between  the  dances  he  sat  by  my  side,  and  I  conversed 
with  him  in  :i  lively  and  natural  way  ;  for  he  impressed  me  as  being  very 
amiable,  fine-mannered,  and  devoid  of  affectation.  He  seemed  very 
grateful  for  my  attention.  When  going  home  he  expressed  a  desire  to 


CONTRARY   SEXUAL   INSTINCT.  287 

walk  along  with  me.  This  seemed  overdoing  the  matter,  for  I  am  not  at 
all  of  a  timorous  nature.  At  the  door,  when  I  was  about  to  open  it,  and 
with  words  of  thanks  put  out  my  hand  to  him,  he  suddenly  seized  me, 
embraced  me  violent!}',  and  grasped  my  genitals.  Surprised,  I  pushed 
him  away  and  asked  him  if  he  were  crazy.  He  stammered  a  few  words 
and  hurried  away.  I  have  never  seen  him  since.  I  did  not  feel  the 
slightest  excitement,  though  this  may  have  been  due  to  the  alcoholics  I 
had  taken. 

"  In  addition,  I  have  one  thing  to  mention  concerning  the  manner 
of  satisfaction  as  I  conceive  it.  According  to  my  experience,  simple 
contact  is  sufficient ;  but  still,  I  should  prefer  to  kiss  my  lover  and  grasp 
his  penis  and  scrotum.  I  think  I  could  easil}'  go  on  to  coitus  inter 
femora  and  masturbation  of  the  other.  To  have  onanism  practiced 
upon  me  is  not  desired.  I  should  like  coitus  inter  femora  by  men  who 
attract  me  sexually,  but  whom  I  do  not  love ;  but  with  my  friend,  whom 
I  really  love,  I  can  think  of  myself  only  in  the  female  role.  Never, 
however,  should  I  allow  immissio  penis  in  anum  or  in  os,  neither  actively 
nor  passively.  In  sexual  relations  I  am  thus  usually  active. 

"  2.  My  attitude  toward  the  female  sex  is  absolutely  indifferent. 
I  neither  seek  nor  avoid  women.  With  educated  ladies  I  am  for  the 
most  part  embarrassed, — a  thing  which,  in  association  with  men,  happens 
only  under  unusual  circumstances.  With  young,  refined  girls,  whom  I 
would  gladly  court,  this  embarrassment  is  still  greater;  but  to  court 
them  I  now  feel  less  capable  than  ever.  With  girls  of  low  position, 
toward  whom  I  have  a  feeling  of  social  superiority,  or  with  those 
already  engaged,  the  sexual  element  is  wanting,  and  I  can  be  friendly 
and  entertaining,  and  I  am  much  esteemed  by  them.  The  sight  of 
female  beauty  excites  my  aesthetic  interest.  If  there  be  associated  with 
it  an  amiable  character  and  genuine  maidenly  conduct,  I  am  able  to 
regard  such  a  person  for  minutes  at  a  time;  but  an  erection  would  be 
impossible.  All  touching  of  female  breasts  and  limbs,  which  I  have 
often  enough  practiced  with  prostitutes  in  the  hope  of  finally  feeling 
sexual  excitement,  has  been  without  avail. 

"  Coitus  is  possible  after  manipulation  by  the  woman  ;  ejaculation 
occurs  as  a  result  of  mechanical  rubbing  of  the  penis  in  the  vagina ;  I 
cannot  value  the  whole  act  of  coitus  as  equal  to  that  of  onanism,  which, 
sadly  enough,  is  indulged  in  in  case  of  necessity.  Moreover,  I  have  not 
attempted  coitus  in  four  years,  at  least.  The  manner  in  which  it  is 
necessar}'  for  me  to  force  myself  to  it  embarrasses  me,  and  its  perform- 
ance fatigues  me  very  much. 

"Twice  I  have  come  into  close  contact  with  the  female  sex.  At 
the  age  of  17  I  made  the  acquaintance  of  a  pretty  girl,  whom  I  might 
have  possessed.  Rendezvous  at  a  garden.  Kisses  and  fondling  of  the 
breasts.  No  erection  or  sexual  approaches.  At  a  ball,  great  jealousy 


288  .SEXUAL    PAR^ESTHESIA. 

of  a  comrade  she  preferred ;  but  I  think  it  was  a  feeling  of  injured 
pride. 

"  On  the  second  occasion  the  object  of  my  attentions  was  a  baker's 
daughter,  whom  I  learned  to  know  at  a  church-festival ;  but  all  at  once 
she  began  to  take  hold  of  me,  and  I  was  so  frightened  that  I  made  my 
escape. 

"  3.  My  dream-life  offers  but  little  noteworthy.  I  dream  almost 
exclusively  of  men  ;  very  seldom  of  women.  It  is  peculiar  that,  at  least 
as  far  as  I  can  remember,  I  have  never  dreamed  of  myself  in  ideal 
sexual  intercourse  with  a  man;  but  men  come  before  my  eyes  like  tifata 
morgana,  do  some  indifferent  act,  and  again  disappear.  They  are  either 
nude  or  tlie}^  have  their  trousers  open  and  the  penis  is  erect,  but  often 
not.  In  the  same  way,  I  cannot  conceive  myself  as  in  the  act  of  coitus 
with  women,  but  they  appear  to  me  nude,  with  firm,  round  breasts,  and 
wandering  about  in  a  garden.  The  breasts  always  please  me  more 
than  the  genitals,  which  interest  me  but  little. 

"  When  I  was  10  years  old  I  once  saw  a  woman  with  large  breasts 
and  repulsive,  long  nipples,  nursing  her  child.  As  far  as  I  know,  erec- 
tion did  not  occur,  but  I  experienced  a  peculiar  feeling,  made  up  of  a 
mixture  of  lust  and  disgust,  which  remained  in  my  memory  for  years. 
Now  the  memory  of  it  has  no  effect  on  me. 

"  Two  years  ago  I  had  a  lively  dream.  I  sat  under  a  tree  in  a 
squatting  attitude,  and  beautiful,  nude  women  fell  down  from  the  tree, 
one  after  another,  into  my  lap,  and  I  had  congress  with  one  after  another 
from  behind.  At  last,  it  became  so  intense  that  I  awoke  and  found  that 
I  had  had  a  copious  ejaculation.  The  penis  was  in  an  unpleasant  erec- 
tion ;  for  the  whole  weight  of  the  bed  clothes,  rolled  into  a  bundle,  had 
rested  on  it,  and  this,  perhaps,  occasioned  the  dream. 

"  4.  My  Character  and  Appearance. — Voice  usually  baritone,  but 
of  higher  quality.  Abundant  growth  of  hair  everywhere.  My  inclina- 
tions are  entirely  masculine.  I  smoke,  drink,  and  like  to  swim  ;  and  I 
should  have  liked  to  learn  to  fence  and  ride,  had  my  means  permitted  it. 

"  In  my  present  state  of  depression  1  avoid  dancing,  but  formerly 
I  was  passionately  fond  of  it,  and  was  considered  a  good  dancer.  I  have 
never  yet  had  any  desire  to  dance  with  a  man. 

"  I  am  very  fond  of  music.  Since  coming  here  I  have  been  at  the 
opera  probably  three  hundred  times.  Too,  I  am  much  interested  in 
languages,  but  my  interest  in  poetry  and  belles-lettres  is  not  above  the 
average  among  educated  people.  My  education  is  not  very  thorough  ; 
I  do  not  know  much  outside  of  the  subjects  pertaining  to  my  occupa- 
tion. In  conversation  I  like  earnest  subjects,  but  I  do  not  object  to 
variety. 

"  In  reading  the  newspapers  I  confine  m3rself  to  politics,  and  am 
well  up  in  such  matters ;  but  I  do  not  despise  a  novel  by  a  recognized 


CONTRARY   SEXUAL   INSTINCT.  289 

author.  In  general  my  reading  is  directed  to  political,  historical,  lin- 
guistic, and  ethnographic  work. 

"  Among  my  friends  I  formerly  occupied  a  middle  position,  but 
now  I  prefer  to  go  my  own  way,  and  I  have  gradually  come  to  be  consid- 
ered eccentric. 

"  I  love  animals,  and  cannot  bear  to  do  harm  to  any  creature.  Mod- 
esty was  once  one  of  my  virtues ;  and  even  now  I  lay  much  store  by 
good  morals  and  respectability,  and  I  can  be  very  severe  when  an 
acquaintance  offends  against  them  seriously.  Ribaldry  is  repugnant  to 
me;  but,  on  the  other  hand,  I  am  fond  of  elegant  equivocation.  I  am 
not  cowardly,  but  good-hearted,  and  all  my  friends  find  fault  with  my 
lack  of  egoism. 

"  I  can  think  logically.  Great  love  of  truth  and  justice,  in  defense 
of  which  I  had  a  duel  with  pistols,  in  which  three  shots  were  exchanged. 
I  am  not  easily  moved,  and  never  weep.  I  am  easily  embarrassed.  No 
preference  for  soldiers.  My  gait  is  firm  and  manly.  Still,  it  seems  to 
me  that  in  the  course  of  my  disease  my  feeling  of  honor  has  suffered.  I 
am  less  scrupulous  in  the  acceptance  of  favors  and  money.  While 
formerly  I  was  quick  to  react  to  insults,  I  now  pass  over  much." 

The  autobiographical  statement  of  the  patient  should  be  com- 
pleted in  some  particulars.  The  sight  of  male  genitals  excites  him 
sexually  only  when  the  face  is  attractive.  He  states  that  he  has  never 
had  erections  at  the  sight  or  thought  of  a  woman.  Psychical  and  tac- 
tile onanism,  which  at  present  is  practiced  on  an  average  once  or  twice  a 
day,  helped  to  invalidate  the  predisposed  nervous  system.  Power  of 
erection  has  suffered ;  occasional  priapism.  No  pollutions  at  night. 
But  there  is  spinal  irritation,  and  painful  sensations  after  onanistic 
excesses. 

The  patient  also  presents  symptoms  of  cerebro-spinal  neurasthenia. 
Dragged  appearance  ;  relaxed  attitude.  Great  irritability  ;  slight  frontal 
headache  on  slight  exertion,  also  after  taking  small  amounts  of  alco- 
holics. Mornings  he  often  lies  in  bed  till  10  o'clock  in  a  doze.  Tired 
on  awaking.  Great  apathy.  Shy  and  suspicious.  Want  of  energy. 
Depressed.  Under  the  influence  of  painful  depression  he  attempted 
suicide  two  years  ago  by  means  of  opium.  The  dose  was  insufficient, 
and  the  patient  was  saved  by  medical  skill.  Again  the  patient  stands  on 
the  verge  of  a  catastroph}7.  At  a  later  visit  the  patient  informed  me 
that  he  had  come  to  me  with  the  determination  to  shoot  himself  should 
my  prognosis  be  unfavorable.  His  ability  to  work  has  suffered  seriously. 
He  is  not  able  to  follow  the  lectures  at  the  university.  Great  confusion. 
Asthmatic  troubles.  Obstipation  alternates  with  diarrhrea.  Unable  to 
pass  his  examinations. 

Sexual  organs  normally  formed  and  of  medium  size.  Mons  veneris 
covered  with  abundant  hair.  Somewhat  anaemic  in  appearance.  Myopic. 


290  SEXUAL    PAR.ESTHESIA. 

MEASUREMENTS   OF   HEAD. 

Horizontal  circumference,      .         .         .         .        .         .58  cm. 

Posterior  half-circumference,          .         .         .         .         .23  cm. 

Anterior  half-circumference, 32  cm. 

Lateral  line  over  vertex, 41  cm. 

Antero-posterior  line  over  vertex,          .         .        .         .30  cm. 

'    Ear-chin  line,          .         .         .         .        .        .         .         .30  cm. 

Greatest  antero-posterior  diameter,       .        .         .         .19  cm. 

Greatest  lateral  diameter,       .         .       ;-,  .         .     15cm. 

Diameter  at  auditory  meati, 12  cm. 

Diameter  at  zygomatic  process  of  frontal  bone,  .     12  cm. 

Distance  from  auditory  meatus  to  root  of  nose,  ,     12  cm. 

MEASUREMENTS   OF   PELVIS. 

Diameter  at  anterior  superior  spines,  .        ,      .  ...        »     23  cm. 

Diameter  at  crests,          .         .         .  ...         .27  cm. 

Diameter  at  tubera  ischii,       .         .  .        .        .        .10  cm. 

Diameter — external  conjugate,       .  .        .         »        .     11  cm. 

Diameter  at  trochanters,         .         .  .         ....     28  cm. 

A  favorable  prognosis  could  be  given,  because  the  patient's  homo- 
sexual tendency,  which  depends  upon  the  imperative  idea  of  male 
genitals,  is  to  be  regai'ded  as  the  product  of  unfortunate  educational 
influences  affecting  an  individual  neuropathic  by  heredity.  All  other 
symptoms — onanism,  neurasthenic  troubles,  tendencies  to  algolagny  and 
exhibition — are  essentially  of  a  secondary  nature.  There  is  the  more 
reason  for  expectation  of  improvement  or  cure  in  this  case,  since  hetero- 
sexual inclinations  are  proved  to  exist,  and  because  the  masculine  char- 
acter, as  such,  has  not  been  involved.  Other. changes  (apathy,  etc.)  are 
to  be  regarded  as  neurasthenic  symptoms  due  to  onanism.  Probable 
duration  of  treatment,  one  year. 

The  treatment,  which  was  begun  on  January  29,  1892,  while  the 
author  was  engaged  on  the  concluding  portions  of  this  work,  was  anti- 
neurasthenic  with  respect  to  the  secondaiy  symptoms. 

Three  points  were  made  in  the  suggestive  therapy  (in  hypnosis)  : 
1.  To  overcome  the  impulsive  onanism.  2.  To  remove  the  imperative 
idea  of  male  genitals  and  the  homo-sexual  inclinations.  3.  Systematic 
cultivation  of  hetero-sexuul  inclination. 

On  the  first  attempt  the  patient  became  somnolent.  Itypotaxis. 
Arms  fixed.  Suggestive  catalepsy.  Deepening  of  the  sleep  by  frequent 
repetition. 

Up  to  the  present  time  the  patient  has  been  subjected  to  twenty 
sittings,  with  very  notable  success.  Since  the  first  day  of  hypnosis 
(during  four  weeks)  complete  absence  of  onanistic  tendencies,  without 
relapse  as  yet ;  mood  pleasant ;  full  of  hope.  During  the  treatment  to 


ALGOLAGNY.  291 

the  present  time  there  have  been  no  homo-sexual  inclinations,  and  ho 
imperative  ideas  of  male  genitals. 

Twice  dreams  of  men  without  pollution. 

On  the  other  hand,  awakening  of  interest  and  desire  for  women. 
He  paints  fancies  of  hetero-sexual  congress,  and  repeatedly  dreams  of 
sexual  situations  with  women,  in  which  he  plays  the  active  role  in  coitus. 
After  a  few  weeks,  desire  to  go  to  a  ball,  which  he  is  advised  to  do. 
Erections  become  more  frequent,  become  stronger,  and  finally  occur 
spontaneously  in  connection  with  hetero-sexual  ideas. 

February  19th,  following  a  suggestion,  he  overcomes  his  shyness 
and  seeks  a  prostitute.  At  the  house,  great  shyness  and  a  desire  to  turn 
back.  The  patient,  who  soon  overcame  his  embarrassment  in  the  pres- 
ence of  the  woman,  was  led  to  drink  too  much  wine,  and  the  absence  of 
erection  he  attributes  to  this.  Nevertheless  he  is  well  satisfied  that  his 
performance  of  the  masculine  role  was  so  successful,  and  on  the  follow- 
ing morning,  in  the  memory  of  the  pleasures  he  might  have  had,  he  had 
"  one  erection  after  another." 

His  sexual  desire  for  women  becomes  more  and  more  prominent ; 
his  general  condition  gives  no  cause  for  complaint ;  and  the  patient  may 
at  present  be  considered  as  essentially  improved.  He  is  still  treated  in 
hypnosis  daily. 

ALGOLAGNY. 

Case  68.  Personal  Observation.  Active  Algolagny  and  Contrary 
Sexual  Instinct  in  an  Individual  Predisposed  by  Heredity.  Improve- 
ment of  the  Algolagnistic  Inclinations  by  Suggestion. — A.,  aged  30  ;  phy- 
sician, Poland.  In  his  youth  his  father  had  a  psychosis,  recovered  com- 
pletely, and  reached  a  great  age.  Father's  sister  was  also  insane,  but 
recovered  and  remained  well.  The  father's  character  was  hard,  despotic, 
and  quick-tempered  ;  he  was  normal  sexually,  though  not  passionate. 
He  was  able  to  keep  from  intercourse  five  years.  Mother,  natura  frigida ; 
never  had  lustful  pleasure  in  coitus.  Four  of  the  children  died,  one 
brother  by  suicide ;  another  brother  is  normal,  married,  and  the  happy 
father  of  several  children.  One  married  sister  is  likewise  a  natura 
frigida  ;  another,  though  unmarried,  seems  to  be  passionate  sexually  ; 
and  three  sisters  seem  normal.  One  of  the  patient's  brothers  seems  to 
be  a  psychical  hermaphrodite ;  at  least,  he  is  given  to  exceedingly  warm 
friendships  with  persons  of  his  own  age,  and  is  said  to  have  lately  fallen 
in  love  with  a  girl. 

The  patient  is  most  closely  attached  to  his  mother.  He  does  not 
remember  to  have  been  ill  before  the  age  of  10.  At  the  age  of  9  A. 
shared  his  sleeping-room  with  a  comrade,  who  often  got  in  bed  with  him. 
On  such  occasions,  in  joke,  A.  grabbed  his  friend  in  the  nates  and  then 
smelled  of  his  fingers.  Patient  cannot  remember  that  this  gave  him 
unusual  feeling  of  pleasure.  This  may  have  happened  four  or  five  times. 


292  SEXUAL    PAK^ESTHESIA. 

Alxnit  this  time  the  patient  introduced  a  lead-pencil  into  his  anus,  and 
he  remembers  that  this  gave  him  a  pleasant  sensation.  The  patient  does 
not  know  whether  it  caused  an  erection  or  not.  At  any  rate,  the  events 
mentioned  seem  to  have  directed  the  attention  of  the  hereditarily  pre- 
disposed boy  to  the  nates  ;  for,  since  this  time,  the  gluteal  region  has 
played  an  important  role  in  the  patient's  imagination.  It  seems  as  if 
the  first  premature  sexual  excitation  had  occurred  simultaneously  with 
the  fancies  mentioned. 

Also  at  school  from  this  time  the  nates  p^ed  a  role.  The  patient 
inquired  of  his  companions  whether  they  had  been  beaten  on  the  nates. 
On  the  other  hand,  A.  does  not  remember  that  he  was  ever  punished  in 
this  way.  With  reference  to  this  point,  the  patient  says  in  his  biog- 
raphy :  "  I  remember  with  distinctness  that  at  that  time  I  often  dreamed 
for  hours  of  how  I  should  do  with  my  children  ;  in  what  cases  they 
would  be  punished,  how  I  should  do  it,  etc.  I  cannot  remember  to  have 
had  erection  or  ejaculation  in  connection  with  this." 

When  10  and  11,  the  patient  "  now  and  then"  introduced  objects 
like  lead-pencils,  penholders,  etc.,  into  his  anus,  but  without  experiencing 
pleasant  sensations  or  erections  as  on  the  first  occasion.  When  a  child, 
he  had  the  bad  habit  of  playing  with  his  genitals,  which  once  induced 
erection,  but  never  ejaculation.  "  When,"  the  patient  continues, "  at  the 
primary  school  I  saw  pupils  punished  on  the  nates,  as  far  as  I  remember, 
I  experienced  no  feeling  of  pleasure.  During  my  time  at  the  gymnasium, 
I  struck  myself  several  times,  as  well  as  I  could,  with  a  Spanish  tube." 
At  the  age  of  15  he  developed  imperative  ideas  of  another  kind.  "  I 
can  still  remember  that  at  a  time  when  I  had  not  yet  developed  neuras- 
thenic symptoms,  in  the  hours  of  worship,  whenever  the  teacher  spoke  of 

the  Holy  Ghost,  I  thought, '  D you,  Holy  Ghost  1'  And  this  gave  me 

intense  pangs  of  conscience.  Now  I  no  longer  doubt  that  at  that  time  I 
was  afflicted  with  an  imperative  idea.  I  also  read  and  re-read  letters 
after  they  were  finished,  to  be  sure  that  they  contained  no  error  in  orthog- 
raphy. I  sometimes  opened,  for  this  purpose,  letters  that  had  been 
sealed." 

Between  the  age  of  16  and  20,  when  A.  bathed  with  companions, 
he  experienced  an  irresistible  impulse  to  spank  them  with  their  trunks 
on, — an  act  which  excited  him  sexually,  but  it  did  not  induce  erection. 
"  Once  I  fell  in  love,"  he  continues,  "  with  a  very  handsome  schoolmate, 
but  without  meeting  with  a  return  of  affection.  A  friend  did  the  same 
thing.  I  am  sure  that,  in  this  matter  with  us  both,  the  sexual  element 
was  not  in  play.  My  friend  is  now  the  happy  father  of  a  family.  I 
desired  to  kiss  my  handsome  schoolmate.  Erections  did  not  occur  with 
the  thought.  At  19  I  now  and  then  had  pollutions  in  sleep,  which  were 
accompanied  by  dreams  of  beating  a  boy  on  the  nates  with  a  switch.  At 
that  time  I  never  had  opportunity  to  talk  of  sexual  matters,  and  thus 


ALGOL  AGNT.  293 

did  not  think  of  the  dreams.  That  as  I  grew  older  the  desii-e  for  women 
would  occur,  seemed  a  matter  of  course." 

After  graduating  from  the  gymnasium  A.  went  to  the  university 
and  began  the  study  of  medicine.  While  at  school  he  had  thought 
much  of  chastity,  and  regarded  non-marital  intercourse  as  u  unprinci- 
pled." In  this  particular  his  education  at  the  hands  of  his  father,  who 
was  very  strict,  may  have  been  to  blame.  Too,  his  mother's  influence 
had  a  very  retarding  effect  upon  his  development.  Against  his  father's 
will  A.  entered  a  societ3'  which  had  chastit}^  as  a  principle. 

The  patient  cannot  remember  to  have  been  in  love  with  any 
member  of  the  society.  As  a  student  of  medicine,  he  first  had  oppor- 
tunity to  see  nude  female  and  male  forms.  At  that  time  examination 
and  touch  of  the  persons  of  both  sexes  induced  neither  erection  nor 
ejaculation.  A.  passed  his  examinations,  and  only  when  a  physician, 
two  years  after  his  examination,  did  he  come  to  understand  his  sexual 
charactei1.  On  examining  the  male  chest,  spontaneous  erections  with 
ejaculations  occurred.  On  this  point  the  patient  writes:  "  At  that  time 
I  read  Niemeyer's  text-book  for  an  explanation  of  the  matter,  but 
found  there  but  a  short,  encouraging  note  concerning  it,  according  to 
which  congenital  inversion  of  the  instinct  was  a  condition  easily  over- 
come, with  the  help  of  the  imagination.  Soon  after  that  I  saw  von 
Krafft-Ebing's  '  Psychopathia  Sexualis,'  and  thus  at  last  the  scales  fell 
from  my  eyes.  Then  came  hours  of  misery.  The  thought  of  never 
being  able  to  marry  often  troubled  me ;  for  I  am  as  one  created  for 
family  life;  delighted  if  I  can  but  stay  with  the  family  for  a  short 
time." 

When  a  student  the  patient  fought  in  several  student-duels,  and 
was  known  as  a  skillful  fencer.  He  served  as  a  one-year  volunteer,  and 
took  delight  in  manly  sports.  When  a  soldier,  it  so  happened  that  he 
was  once  forced  to  spend  the  night  in  a  room  with  a  friend.  Though 
no  deep  feeling  attached  him  to  this  3Toung  man,  one  evening,  after  he 
was  in  bed  and  while  his  friend  had  not  yet  come  in,  he  thought  he  would 
induce  his  companion  to  beat  him  on  the  nates.  For  this  purpose  A. 
left  the  light  burning,  and,  pretending  to  be  asleep,  he  uncovered  his 
gluteal  region  and  placed  himself  so  that  his  nates  would  immediatelj" 
catch  his  friend's  eye  as  he  entered.  The  patient  hoped  that  he  would 
give  him  a  sounding  blow.  But,  to  his  chagrin,  he  made  no  use  of  his 
opportunity. 

In  medical  practice  boys  from  10  to  14  years  old  have  the  prin- 
cipal charm  for  the  patient.  In  no  case  are  such  persons  to  be  more 
than  26  3Tears  of  age.  Absence  of  beard  is  another  condition  ;  but  a 
small  moustache  does  not  prevent  excitement.  Whenever  the  patient  is 
concerned  in  his  practice  with  young  persons  fulfilling  these  conditions, 
he  feels  an  impulse  to  beat  them  on  the  nates ;  but  the  impossibility  of 


294  SEXUAL    PARJESTHESIA. 

performing  such  an  act  does  not  trouble  him.  Tn  pi-actice,  whenever 
possible,  he  gets  a  sight  of  the  nates.  And  he  never  fails  to  ask  his 
patients  whether  they  have  been  punished  at  school.  During  such 
questioning  he  has  frequently  had  erections  with  subsequent  ejacula- 
tions. 

In  his  autobiography  the  patient  thus  describes  his  sadistic  inclina- 
tions :  "  A  handsome,  youthful  face;  finely-developed  thorax;  powerful 
thighs,  but  especially  beati fully-rounded  nates,  charm  me.  On  the  other 
hand,  male  genitals  are  indifferent.  Once  I  saw  a  friend's  penis  in  erec- 
tion. A  boy  of  14  once  had  erection  on  lowering  his  trousers  to  facili- 
tate examination.  The  boy  had  ejaculation.  In  this,  however,  I  experi- 
enced no  lustful  pleasure,  but  rather  a  feeling  of  disgust.  The  thought 
came  to  me  that  he  certainly  was  given  to  onanism,  and  that  I  should 
spank  him  soundly. 

"  Whenever  I  have  opportunity  I  cannot  resist  the  temptation  to 
touch  the  nates  with  my  hand.  The  anus  also  charms  me  to  a  certain 
extent,  in  spite  of  my  aesthetic  disgust.  Whenever  I  have  occasion  to 
make  a  digital  examination  (for  haemorrhoids  and  the  like),  I  have  in 
the  act  a  feeling  of  lustful  pleasure,  which,  however,  is  followed  by  a 
feeling  of  disgust.  Vaginal  examinations,  or  female  nudity  in  general, 
have  not  the  slightest  sensual  effect  on  me.  I  have  no  horror  feminae ; 
only  one  specific  female  odor  is  unpleasant  to  me. 

"  I  must  mention  here  that  last  year  I  had  erection  while  reading 
in  a  newspaper  how  in  London  certain  parents  sold  their  daughters  to 
persons  to  beat  ad  nates." 

These  statements  are  to  be  supplemented  as  follows:  The  patient' 
is  excited  sensually  only  when  he  can  give  pain  to  young  persons  aged 
from  10  to  26  years.  At  the  same  time  he  is  contrary  sexually  and 
actively  algolagnistic.  Though  the  nates  play  the  principal  role  in  his 
fancy,  still  other  acts  which  inflict  pain  cause  him  sexual  excitement. 
These  are  especially  all  operations  on  persons  having  the  characteristics 
previously  mentioned.  For  example,  in  scraping  out  the  ear  for  lupus  and 
in  making  injections  of  all  kinds  A.  has  erections  and  ejaculations.  His 
lust  in  giving  pain  is  so  great  that  of  late  years  the  patient  has  several 
times  sought  to  beat  himself,  but  without  experiencing  any  intense 
excitement.  On  the  other  hand,  the  same  longing  drove  l\'\m,faute  de 
mieux,  to  practice  injections  of  distilled  water  on  himself.  Orgasm  and 
ejaculation  on  the  second  attempt.  No  week  of  his  practice  passes 
without  the  occurrence  of  sexual  excitement  of  this  kind.  He  never 
has  any  desire  to  kiss  the  object  causing  him  excitement,  but  merely  the 
sight  of  the  thighs  and  nates  immediately  induces  erection. 

A.  makes  the  following  statement  concerning  his  character:  "My 
mental  endowment  is  that  of  the  average  man.  Desire  for  comfort ;  I  am 
soft  and  yielding.  I 'am  but  little  touched  by  the  suffering  of  others. 


ALGOLAGNY.  295 

It  is  difficult  for  me  to  refuse  a  request  to  any  one.  As  for  the  rest,  I 
have  no  feminine  inclinations.  For  female  toilettes  I  have  not  the 
slightest  taste,  and  thus  have  often  angered  this  or  that  lady  of  my 
acquaintance.  I  am  not  vain  or  anxious  to  please.  I  have  no  under- 
standing of  feminine  occupations.  Aside  from  my  occupation,  my 
interest  is  principally  in  politics,  history,  and  legal  matters.  I  was  a 
skillful  fencer,  and  took  part  in  live  student-duels.  To  physical  pain, 
operations  on  the  teeth,  the  suturing  of  gashes,  I  am  almost  insensitive. 
In  the  society  of  women  I  am  shy, — that  is,  with  young  ladies  unknown 
to  me.  On  the  contrary,  I  like  to  associate  with  married  and  unmarried 
ladies  with  whom  I  am  intimate.  The  thought  of  marriage  with  a  young 
girl  is  attractive.  I  have  often  had  waking  dreams  about  it ;  how  nice 
it  must  be  to  have  a  pretty  wife  at  one's  side  in  bed.  But  always  the 
thought  would  come, '  You  cannot  have  congress,'  and  this  would  make 
an  end  of  my  dream." 

Neurasthenic  symptoms  had  only  been  noticed  by  the  patient  of 
late.  Incited  by  Moll's  work,  "  Contrary  Sexual  Instinct,"  which  the 
patient  read  with  interest,  he  began  to  cultivate  hetero-sexual  thoughts, 
the  object  of  which  was  an  attractive  friend  of  his  sister.  During 
the  night  of  October  20,  1891,  he  dreamed  that  he  must  begin  hetero- 
sexual intercourse,  and  he  awoke  with  a  dull  head.  During  the  next 
week  the  patient  felt  neutral  sexually.  On  the  other  hand,  every  night 
lie  had  feelings  of  anxiety  which  "  apparently  depended  upon  the  idea 
that  he  must  be  insane."  Then  erections  at  the  sight  of  boys  again 
occurred.  "  Now,"  says  the  patient,  "  came  the  thought,  '  You  cannot 
be  normal  if  you  are  excited  sexually  by  men.'  That  passed  away.  On 
the  other  hand,  unexpectedly  came  this  imperative  idea, '  You  are  not 
insane.'  Darting  pains,  restless  sleep,  and  disquieting  thoughts  of  sui- 
cide and  the  asylum  troubled  me." 

A  journey  brought  him  to  Munich,  and  he  visited  me  on  November 
19,  1891. 

The  patient's  appearance  was  thoroughly  masculine.  Abundant 
development  of  adipose  tissue;  beardless;  abundant  growth  of  hair. 
Hair  blonde.  No  noticeable  approach  to  the  female  type  in  the  form  of 
the  pelvis  or  the  position  of  the  thighs.  Internal  organs  healthy. 

FORM    AND    MEASUREMENTS    OP    HEAD. 

Male.  Female. 

1.  Horizontal  circumference,      .         .     60.0  cm.     55.0  cm.  53.0  cm. 

2.  Posterior  half-circumference,         .     23.0  cm.     24.0  cm.  22.0  cm. 

3.  Anterior  half-circumference,          .     32.0  cm.     30.0  cm.  28.0  cm. 

4.  Lateral  line  over  vertex,        .         .     33.0  cm.     36.0  cm.  34.0  cm. 

5.  Long  line  over  vertex,  .         .         .     36.0  cm.     35.0  cm.  33.0  cm. 

6.  Ear-chin  line,        ••.•       .         .         .     29.0cm.     30.0cm.  28.0cm. 


296  SEXUAL    PAR^ESTHESIA. 

CALIPER-MEASUREMENTS. 

Male.  Female. 

1.  Long  diameter,      ....  18.0cm.  18.0cm.  17.5cm. 

2.  Greatest  lateral  diameter,      .         .  16.0  cm.  15.0  cm.  14.0  cm. 

3.  Diameter  at  auditory  meati, .         .  12.0  cm.  12.5  cm.  11.5  cm. 

4.  Diameter  at  zygomatic  process,    .  12.5cm.  11.0cm.  11.0cm. 

5.  Distance  from  auditory  meatus  to 

nasal  spine,      .         .         .         .     12.0  cm.     12.0  cm.     11.0  cm. 

6.  Breadth-index,       ....     88.0  80.0  70.0 

PELVIC    MEASUREMENTS. 

Diameter  at  anterior  superior  spines,         .         .         .  26.0  cm. 

Diameter  at  crests, 28.5  cm. 

Diameter  at  trochanters, 31.5  cm. 

Diameter — external  conjugate,  .         .  •      .         .         .  21.5  cm. 

The  foregoing  history,  made  up  of  the  patient's  statements 
and  autobiography,  requires  but  few  additions. 

The  patient's  dreams  are  infrequent  and  are  usually  about  whip- 
ping. After  reading  von  Krafft-Ebing's  "  Psychopathia  Sexualis," 
patient  twice  dreamed  of  performing  pederasty  with  boys,  which  induced 
ejaculation  ;  more  frequently,  however,  ejaculation  occurred  when  he 
dreamed  that  lie  beat  the  boy  on  the  nates  with  his  penis.  In  the  waking 
state  he  abhors  the  act  of  pederasty.  A.  often  takes  his  genitals  in  his 
hands  and  looks  at  the  reflexion  of  his  nates  in  a  mirror,  finding  great 
pleasure  in  the  procedure.  It  gives  him  special  pleasure,  during  the 
heat  of  summer,  to  walk  about  his  room  naked.  Stroking  his  nates,  even 
when  he  does  it  himself,  gives  him  lustful  pleasure. 

With  the  exception  of  rheumatism  and  typhoid  fever  in  1885,  the 
patient  has  had  no  illness.  Besides  the  neurasthenic  troubles  mentioned, 
he  is  often  troubled  with  pressure  in  his  head.  He  does  not  smoke,  but 
he  drinks  five  or  six  glasses  of  beer  daily  (a  glass  contains  about  ^  litre). 

With  the  masculine  character  of  the  patient,  and  in  that  he  had 
never  attempted  coitus,  it  was  possible  to  give  a  favorable  prognosis. 

November  21st.  First  attempt  at  hypnosis.  A.  immediately  be- 
comes somnolent,  and,  with  a  correct  understanding  of  the  hypnotic 
procedure,  seeks  to  increase  the  influence  auto-suggestively.  He  passes 
into  hypotaxis.  Suggestions  :  (a)  Abhorrence  of  male  nates,  the  inflic- 
tion of  pain,  and  homo-sexual  desires.  (6)  Interest  in  women  and  pref- 
erence of  them.  Occurrence  of  erection  at  ideas  of  hetero-sexual  char- 
acter, (c)  Cessation  of  imperative  ideas  and  neurasthenic  symptoms. 

November  22d.  The  patient  has  thought  much  of  female  nates 
without  experiencing  any  feeling  of  repugnance.  Otherwise,  condition 
unchanged.  Treatment  and  suggestion  as  yesterday. 


ALGOLAGNY.  297 

November  23d.  Last  night  A.  dreamed,  as  a  result  of  suggestion, 
that  he  abhorred  men,  and  that  boys'  nates  no  longer  made  any  impres- 
sion on  him.  To-day  the  patient  developed  the  imperative  idea  that  he 
could  not  be  hypnotized  if  he  put  on  any  other  than  the  suit  of  clothes 
he  wore  yesterday.  Repetition  of  the  procedures  of  yesterday. 

November  24th.  No  progress  of  importance.  To-day  coitus  and 
success  in  it  are  suggested.  Hypnosis  and  suggestions  as  usual. 

November  25th.  Yesterda}r  the  patient  was  in  a  brothel,  and  had  no 
success  whatever.  Tlie  puella  continued  manipulation  ad  genitalia  for 
twenty  minutes  without  inducing  erection.  The  patient  tried  to  induce 
excitement  by  looking  at  the  woman's  nates  ;  but  this  was  also  without 
effect.  Complete  fiasco.  Energetic  suggestive  treatment  looking  to 
progress,  and  to  quiet  A. 

November  26th.  Last  night  A.  dreamed  of  women,  and  had  erec- 
tion on  waking,  but  he  could  not  state  that  there  was  an}'  relation  be- 
tween them.  Hypnotic  treatment  as  usual. 

November  27th.  Last  night  dreams  of  boys,  with  erection.  The 
general  condition  improves ;  imperative  ideas  disappear.  Repetition  of 
the  procedure. 

November  28th.  The  same  treatment  as  yesterday. 

November  29th.  Last  night  dreams  of  whipping  and  of  women,  with 
erection.  Pollution  without  dreams.  Suggestive  treatment.  Success 
in  coitus  promised  for  to-night. 

November  30th.  The  patient  spent  all  last  night  with  a  puella. 
Toward  morning  erection  occurred,  but  it  disappeared  as  soon  as  the 
girl  touched  the  organ.  Complete  fiasco.  General  condition  better. 
Treatment  as  usual.  Homo-sexual  dreams  the  next  night. 

December  1st,  2d,  and  3d.     Hypnosis  daily. 

During  the  night  of  December  3d  erection  occurred  with  a  puella, 
and  immissio  penis  was  successful,  but  erection  disappeared  without  the 
occurrence  of  ejaculation, — a  little  progress. 

December  4th.  The  usual  procedure. 

December  5th.  Last  night  another  attempt  with  a  member  of  the 
demi-monde.  Again  erection  and  immissio  penis.  Friction  continued 
four  minutes  without  the  occurrence  of  ejaculation.  Attempt  abandoned. 
H3Tpnotic  treatment. 

December  6th.  The  patient  attempted  to  induce  ejaculation  by 
means  of  onanism,  in  order  to  facilitate  it  with  a  woman.  But  he  does 
not  succeed.  Erection  occurs,  but  not  ejaculation.  Hypnotic  treatment. 

December  8th,  9th,  and  10th.  Daily  hypnosis  without  essential 
change.  Onanistic  attempts  always  unsuccessful.  Careful  local  examina- 
tion of  the  genitals,  made  b}*  a  specialist  at  my  instance,  gives  a  negative 
result. 

December  llth  and  12th.  Hypnosis. 


298  SEXUAL    PARyESTHESIA. 

December  14th,  owing  to  his  business,  the  patient  was  forced  to 
suspend  treatment,  but  he  intended  to  submit  himself  to  further  treat- 
ment as  soon  as  he  could  have  time  for  it.  He  was  discharged  as 
slightly  improved. 

Three  weeks  after  his  departure  A.  wrote  me  as  follows:  "Here, 
during  the  first  few  days,  I  noticed  immediately  that  the  contrary  sexual 
feeling  was  scarcel}'  changed.  I  have  at  various  times  had  erection  and 
ejaculation  while  examining  young  men ;  but,  expressing  myself  with 
caution,  it  seems  to  me  that  the  sadistic  tendencies  have  disappeared. 
After  a  longer  period  of  observation  I  shall  be  able  to  send  you  a  more 
exact  report.  My  general  condition  is  much  better ;  I  am  much  less 
troubled  by  imperative  ideas.  Appetite  and  sleep  are  excellent." 

I  advised  the  patient  to  use  the  erection  induced  b3T  the  sight  of 
male  nates  to  attempt  coitus.  Four  weeks  later,  on  January  3,  1892, 
the  patient  again  confirms  his  former  statement,  and  says,  "  The  sadistic 
inclinations  seem  to  have  actualty  disappeared."  From  this  the  patient 
must  be  regarded  as  improved  with  respect  to  his  algolagnistic  desires ; 
likewise  in  respect  to  his  general  condition.  On  the  other  hand,  the  con- 
traiy  sexual  instinct  still  exists  unchanged,  and,  in  my  opinion,  will  not 
be  overcome  until  regular  hetero-sexual  intercourse  has  become  possible. 
While  the  power  of  erection  has  improved,  it  is  still  difficult  to  excite 
the  ejaculation-centre..  In  spite  of  the  relatively  slight  success,  the  case 
offers  prospect  of  cure,  or  of  essential  improvement.  This  task,  which 
is  none  too  easy,  remains  for  a  future  repetition  of  the  suggestive 
procedure. 

Case  69.  Personal  Observation,  A  Case  of  Paraesthesia  Sexualis 
(Rudimentary  Passive  Algolagny?)  Successfully  Treated  by  Suggestion. 
— Male,  aged  27  ;  official.  No  hereditary  predisposition.  Diseases  of 
childhood.  Onanism  since  his  eighth  year.  In  his  sixteenth  year  the 
patient  once  had  a  pollution  while  having  his  hair  cut  in  a  barber-shop, 
due,  as  he  says,  to  pressing  his  thighs  together  while  his  fancy  was  occu- 
pied with  lascivious  images.  From  his  eighteenth  to  his  twenty-third 
year,  normal  intercourse  with  women.  At  the  same  time  there  were 
long  periods  (six  to  nine  months)  in  which  there  was  no  intercourse  at 
all.  In  these  periods  of  continence  especially  he  was  often  subject  to 
the  thought  of  having  his  hair  cut,  and  this  was  accompanied  by 
erection. 

The  inadequate  stimulus  of  hair-cutting  became  a  factor  in  inducing 
excitement  of  the  sexual  sphere,  usually  inducing  lustful  feelings,  some- 
times ejaculation.  Too,  in  his  dreams  the  shears  of  the  barber  pla3-ed  a 
more  effectual  part  in  inducing  pollutions  than  did  ideas  of  hetero- 
sexual intercourse.  The  patient  had  often  clearly  seen  the  repulsive  and 
unnatural  character  of  his  ideas,  but  he  became  powerless  in  combating 
this  imperative  idea.  Whether  the  psycho-sexual  process  mentioned  is 


ALGOLAGNT.  299 

to  be  regarded  as  a  symbolic  act  of  the  nature  of  masochism  (vide  von 
Krafft-Ebing) — i.e.,  passive  algolagny — or  merely  as  an  associated  result, 
due  to  habit,  of  an  accidental  occurrence  accompanied  by  intense  emo- 
tion, cannot  be  determined  with  certainty.  Too,  this  case  was  observed 
one  year  before  the  appearance  of  von  Krafft-Ebing 's  first  publication  on 
masochism. 

In  coitus  erection  is  incomplete,  ejaculation  delayed.  The  patient 
painfully  realizes  the  perversity  of  his  sexual  character,  is  much  depressed, 
and  complains  of  neurasthenic  symptoms,  which  are  to  be  regarded  as  a 
result  of  his  sexual  anomaly,  especially  his  onanism.  Melancholy ; 
hypochondria ;  frequent  physical  examinations  by  several  physicians 
merely  out  of  anxiety,  but  with  negative  results ;  loss  of  self-confidence ; 
sleeplessness  due  to  grubelsucht.  Neuropathic  expression  of  eyes ; 
changeable  subjective  complaints.  Physically  the  patient  appears  to  be 
in  blooming  health.  Tendency  to  extremes ;  unnatural,  feverish  ambi- 
tion in  his  occupation,  which  he  has  changed  several  times.  Formerly 
imagined  heart  disease,  concerning  the  absence  of  which  the  patient  is 
now  re-assured.  His  inconstant  character  and  his  dependence  upon  the 
mood  of  the  moment  make  the  possibility  of  systematic  treatment  seem 
doubtful.  Like  so  man}'  others,  the  patient  believes  that  he  cannot  be 
influenced  in  an  h3-pnotic  sitting. 

In  October,  1889,  the  patient  submitted  to  irregular  hypnotic 
treatment.  In  the  time  from  October  llth  to  22d  the  sleeplessness  was 
overcome  by  suggestion.  At  the  same  time,  quieting  psycho-therapy  in 
the  waking  state.  Increase  of  self-confidence.  The  first  attempt  at 
coitus,  after  a  long  period  of  continence,  was  made  October  20th,  as 
a  result  of  hypnotic  suggestion.  Moderate  lustful  feeling;  incomplete 
erection  ;  delayed  ejaculation.  From  this  time  until  the  middle  of  No- 
vember the  patient  discontinued  treatment  without  any  reason,  and  sub- 
mitted to  hypnosis  but  three  times  more, — from  the  9th  to  the  16th  of 
November.  On  November  15th  coitus  was  more  successful  and  gave 
him  more  satisfaction.  Inclination  to  have  his  hair  cut  opposed  \)y 
suggestion  in  each  sitting,  and  also  fanciful  ideas  of  that  nature  both 
while  awake  and  in  dreams  ;  on  the  other  hand,  lively  interest  in  women 
and  greater  self-confidence  were  suggested.  Gonorrhoea  brought  our 
efforts  to  an  involuntary  end  ;  and  there  has  since  been  no  hypnotic 
treatment. 

The  patient  always  passed  only  into  a  state  of  slight  lethargy ;  no 
amnesia,  but  he  always  felt  very  well  after  waking.  The  result  of  psy- 
chical treatment  both  in  the  waking  and  hypnotic  state  (fourteen  sit- 
tings) is :  disappearance  of  subjective  troubles,  especially  sleeplessness, 
and  the  depression  and  hypochondriacal  preoccupation.  Suggestion  in 
the  slightest  degree  of  hypnosis  proved  to  be  more  effectual  than  simple 
advice. 


300  SEXUAL    PAR^ESTHESIA. 

The  ideas  of  hair-cutting  retired  into  the  background,  and  during 
treatment  played  no  part  at  all.  After  the  patient  had  been  induced,  by 
means  of  suggestion,  to  repeatedly  perform  coitus,  and  after  these 
attempts  had  proved  so  successful,  even  though  not  brilliantly,  that  the 
patient  had  regained  self-confidence,  as  soon  as  the  gonorrhoea  was  cured 
he  entered  into  a  relation,  as  he  informed  me  later.  The  consequent 
regular  sexual  congress  exercised  a  favorable  ps}-clio-sexual  reflex  effect ; 
it  grew  more  and  more  successful,  finally  satisfied  the  patient  completely, 
and  prevented  all  return  of  the  perverse  ideas  previously  mentioned. 

After  six  months  the  patient  presented  himself  as  cured  ;  and 
when  I  saw  him,  in  May,  1891,  he  was  satisfied  in  every  way  with  his 
state  of  health  and  his  sexual  power. 

In  this  case  hypnotic  therapy  could  not  be  employed  systematically 
enough,  but  it  nevertheless  brought  about  essential  improvement,  though 
in  combination  with  psychical  treatment  in  the  waking  state. 

Case  70.  Personal  Observation.  Passive  Algolagny  (Flagellation) 
and  Other  Perverse  Hetero-sexual  Activity  of  the  Instinct  Essentialty 
Improved  by  Suggestive  Treatment. — S.,  aged  31 ;  married.  Father  died 
of  cerebral  softening.  Mother  and  other  members  of  family  healthy. 
At  18  pneumonia,  with  serious  relapse  ;  since  then  weakness  of  lungs, 
cardiac  palpitation,  and  asthmatic  symptoms.  Condition  otherwise 
satisfactory. 

The  patient  appears  weak  and  delicate.  Relaxed  muscular  system ; 
general  nutrition  good.  Inclination  to  dyspepsia;  flatulence;  obstipa- 
tion ;  unstable  ;  pulse  increased  by  the  slightest  emotion. 

According  to  S.'s  autobiographical  statement,  his  sexual  appetite 
appeared  in  his  tenth  year,  but  his  desires  were  directed  exclusively  to 
active  and  passive  flagellation.  In  his  thirteenth  and  fourteenth  years 
these  ideas  disappeared.  First  pollution  in  his  fifteenth  year.  One 
year  later,  first  masturbation.  After  that  onanism  was  practiced  regu- 
larly until  his  eighteenth  year,  but  without  ideas  of  coitus.  "  But  my 
only  desire,"  writes  the  patient,  "  was  masturbation  performed  by  a 
female,  or  some  other  unnatural  satisfaction, — flagellation  by  her,  for 
example."  In  the  various  sexual  acts  the  patient  was  alwa}'s  in  the 
passive  role.  He  says,  farther,  "  Coitus  seemed  unattractive  to  me. 
In  my  twenty-first  year  I  tried  it  for  the  first  time,  but  was  unsuccess- 
ful ;  thereafter  it  was  somewhat  better,  and  I  then  had  congress  quite 
regularly  with  women,  but  without  real  pleasure  (onanistic  acts  on  the 
person  of  the  woman) ;  for  a  certain  fear  disturbed  me,  and  three  years 
ago  I  was  very  unsuccessful  several  times  in  succession.  Since  this  time 
I  have  avoided  it,  and  I  have  not  had  the  moral  courage  to  venture 
farther  trial  of  it.  Since  then  I  have  limited  myself  in  hetero-sexual 
congress,  which  is  very  passionate,  to  some  unnatural  act  of  indulgence, 
and  in  these  acts  I  feel  extraordinarily  potent.  In  these  cases  erection, 


ALGOLAGNY.  301 

which  formerly  was  delayed,  occurs  instantly.  After  such  intercourse  I 
always  feel  well  mentally,  and  morally  satisfied,  if  the  thought  that  the 
thing  is  abnormal  does  not  trouble  me." 

D 

Irritable  weakness  of  the  ejaculation-centre,  probably  due  to  sexual 
abuse.  Insufficient  erection  and  premature  ejaculation  in  attempts  at 
coitus.  The  patient  tries  to  find  other  reasons  for  the  perverse  act  of 
sexual  gratification.  Thus,  he  declares  that  his  companions  prefer  the 
perverse  manner  of  indulgence,  and  do  not  permit  him  to  attain  to 
coitus ;  besides,  he  wishes  to  avoid  causing  pregnancy.  The  perverse 
substitutes  consist  of  passive  flagellation  by  the  hand  of  the  woman, 
mutual  masturbation,  and  coitus  in  os.  In  these,  as  mentioned,  he  is 
always  potent.  Impotence  in  the  natural  act  increased  with  the  frequent 
and  regular  repetition  of  these  acts.  The  pathological  sexuality,  which 
may  be  regarded  as  partly  due  to  the  inherited  neuropathic  constitution, 
and  partly  to  unfavorable  educational  influences,  is  felt  to  be  a  hindrance 
to  married  life.  Therefore  he  desires  help  through  psycho-therapeutic 
procedures.  From  the  19th  of  October  to  the  21st  of  December,  1889, 
nineteen  sittings. 

At  the  first  attempt  great  somnolence,  hypotaxis.  After  waking, 
indistinct  memory. 

Energetic  suggestions :  (a)  Abhorrence  of  the  perverse  acts.  (6) 
Increasing  inclination  to  natural  intercourse,  (c)  Complete  power  in 
coitus,  self-confidence,  and  erection,  (d)  Physical  health. 

After  the  second  hypnosis,  attempt  at  coitus  in  a  cab.  Complete 
fiasco ;  premature  ejaculation  with  relaxed  organ. 

The  suggestions  of  October  29th  are  regularly  repeated  in  the 
following  sittings.  Hypnosis  increasing  to  somnambulism. 

There  were  sittings  October  31st,  November  2d,  4th,  5th,  6th,  7th, 
9th,  llth,  12th,  19th,  28th,  30th,  31st,  and  December  2d,  10th,  16th, 
18th,  21st. 

November  2d.  Erection  better,  but  it  disappears  in  the  perform- 
ance of  the  act. 

November  4th.  Relapse;  coitus  in  os. 

November  6th.  Normal  coitus  performed,  though  with  incomplete 
erection,  and  without  lustful  pleasure  like  that  experienced  in  perverse 
acts. 

November  9th.  Erection  better.  The  patient  has  congress  in  the 
normal  way,  but  the  abnormal  equivalent  is  still  pleasanter,  in  spite  of 
energetic  opposing  suggestion. 

November  12th.  S.  has  more  pleasure  in  natural  .intercourse ; 
erection  improves. 

November  19th.  Relapse  at  a  woman's  instance.  My  advice  to 
break  off  the  relations  with  this  woman  he  rejects. 

November  28th.  Very  deep  somnambulism  is  induced  by  means  of 


302  SEXUAL    PAR^STHESIA. 

longer  continuance  of  the  hypnosis  (half  an  hour).  Very  energetic  idea, 
as  already  imparted.  After  this  sitting  moderate  feeling  of  dullness, 
which  disappears  when  he  gets  out  into  the  open  air. 

December  2d.  Coitus  again,  normal  and  with  good  success  and 
complete  satisfaction.  In  the  following  sittings  up  to  December  21st 
permanent  success  suggested. 

Treatment  had  to  be  discontinued  on  account  of  an  attack  of  in- 
fluenza, and  was  not  resumed.  I  have  had  no  opportunity  to  get  any 
news  of  the  patient's  subsequent  condition.  During  the  last  two  weeks 
of  treatment  the  patient's  inclination  to  perverse  acts  had  decreased 
considerably. 

At  any  rate,  suggestive  treatment  made  the  patient  able  to  perform 
coitus  in  a  normal  way,  which  previously  had  been  impossible ;  though, 
owing  to  the  short  time  he  was  treated,  it  is  not  to  be  expected  that  in 
the  future  erection  will  be  complete  and  occur  regularly.  Nevertheless, 
in  this  case  the  essential  improvement  attained  by  suggestion  is  note- 
worthy, and,  like  the  other  cases,  it  points  out  the  way  in  which  com- 
plete cure  is  to  be  produced. 

CONCLUDING  REMARKS. 

The  table  on  the  opposite  page  shows  the  results  in  thirty- 
two  cases,  which  may  be  arranged  as  follows : — 

Failures, 5    =    15.625  per  cent. 

Slightly  improved, 4    =    12.5      per  cent. 

Essentially  improved, 11    =    34.375  per  cent. 

n       ,    ( with  later  report,      .      10)     10           0>T  e 
Cured,  <                                                }•     12    =    37.5      per  cent, 
(.without  later  report,        2)     

32          100.0      per  cent. 

Of  the  32  patients  5  were  not  amenable  to  hypnosis ;  8 
passed  into  somnambulism,  13  into  hypotaxis,  and  3  became 
only  somnolent.  In  3  cases  the  degree  of  susceptibility  is  not 
given  by  the  authors.  More  than  one-third  of  the  cases — that 
is,  12  of  the  32 — were  completely  cured;  and  in  10  of  these 
it  was  possible  to  determine,  by  later  observation,  that  the  cure 
was  persistent.  In  several  cases  the  period  of  observation  ex- 
tended over  a  year.  Indeed,  von  Kraft't-Ebing  observed  one 
case  two  years ;  and  I  had  opportunity  to  watch  a  discharged 
patient  two  years  and  seven  months.  Four  other  patients  were 
kept  under  observation  more  than  a  year,  and  a  somewhat  larger 
number  longer  than  six  months. 


CONCLUDING    REMARKS. 


303 


? 

•viO^O^^C^O^C^^OO^AC^CnCTi      Q71      cncnoiCnCnOi      •»•       ^-  ^-  «  _                i^-.  —  ^-  ^.  j*  co 
o«5o^i3:;j>4*'W't5H-o®OD*j      w     o»^»wio^-o     <»     OOM»OI              ***c*3bo^-o55 

GASES. 

|.|ssssj.|:s.          ,           ;;;;;;          \          :j                                                        | 

|      |                               |        1                                                                                                          |                                                          | 

III  !|l  '                    1           ! 

11*          el?                              g                1 

D                                                                                •'••**•  '3 
o                                                                      o                                   o 

J» 

ffi1 

I 

• 

<i                 <i                   S                   <i 

§            §            3l             § 

.    M      .                               M>             9                   OVO                                          M 

f>r*5     t*                        rig         o                 e»o                                     ?^ 

H 

H 

•0 
O 

i 

F 

5"                      S*                      P*s 

g 

Male. 

Sax. 

£ 

.     ^.     ^H-h-.     .     h-.     h-.     *-.           .           H-.     .     .     H-.           h-        .     .     h-.                        h-h-H-.     .     . 

20-30. 

O 

w 

s: 

N-;  M*.  1  1  1  •-!  *-i  ~i  !  -  !•-!•-!-  ;  h-h-:  -     .  :  :  :  ~~ 

30-40. 

M 



40-50. 

i 

*^,  •       — 

Sittings. 

co 

Somnolence. 

.i-1..   .t-1  ..-»..        .'-'.. 

5 

•  •  •      

Hypotaxis. 

00 

Somnambulism. 

O< 

!-•         .      .                    I-"                                    t—  .      l-l  .                    .      .     •-• 

Failure. 

* 

Temporary. 

IMPROVE- 
MENT. 

h*.     1-".     .     I-".     ..I-1...                                            .. 

p 

,_,*     '     *     ,_,'     '     ^,,_,  "     ,_,                    ^^        "     "     ^j'                              *     p_,|_i                    "     ,_i"     ,_i"     * 

Great. 

CO 

F'th'r  Co'rse 
Unknown. 

.           .           .. 

0 

'    •           ,        

With  Later 
Report. 

O 
H 

M 

Without 
Later  Report. 

:  :  :  :  :   :  :  >-  ^- 

-» 

»-"i-i     i-o—.                     ta                                                                  ^     ~»>^. 

Relapse. 

C»C>     CC^O     M^     H     >•     Sr'tIO     H     CtHC            H     H     >5* 
"i  *3  'S  2  -3     f  I  2  5     ?  =  ?  o  <L2     s~^  >£~-'^"  5~n'.2:r£-':0-??>     S     5» 
*  2.2.2.  s     2.3  =  3     19  S  fie           3       f?&    *ff§x5§§           ?  ^ 

^J  2:  2.  s  o     s  =  n  o    §  o"  »  g  3  s.    i--Sws3so§^^g-  —•<•<_  _^    i"    g>  rt 

slf.gc   -I*       Sxial       i  Igfl^l  11  s"  Z  3-^ 

frg-S    &                     g3srt2.         ft    g»&'  g,S    •  "So    : 
g*<        2           E          S    x?P           I    =-g|92o        o^S    g     : 

vS  T3          Q.              B                      1^      ^3              ^*      o  fl5      *^  o              r*  ® 

?3                 i*              ^    s         s    l."5    =§•         ?=•£ 
5                                      ,B-on«§c-«f          |^ 

•                                                                     IB        O                   <B              c>         /  ... 
*                                                                     ?       &                                   if*                   &P.P, 

REMARKS. 

304  SEXUAL    PAR^STHESIA. 

The  certainty  of  this  manner  of  observation  and  the  care- 
ful report  of  relapses,  which  are  seldom  to  be  met  with  in  other 
branches  of  therapeutics,  justify  us  in  drawing  almost  certain 
conclusions  from  the  material  at  hand  concerning  the  prospects 
of  cure  in  cases  of  sexual  parsesthesia.  The  probability  of  success 
with  suggestion  may  be  expressed  as  70  per  cent.,  that  of  cure  as 
34  per  cent. ;  but,  as  a  rule,  one  should  prepare  such  patients  for 
the  necessity  of  prolonged  treatment.  In  one  case  one  hundred 
and  forty-two  sittings  were  necessary,  and  in  another  two  hun- 
dred and  four.  Too,  it  may  be  recommended  that,  in  order  to 
make  the  cure  lasting,  the  patient  should,  as  a  prophylactic,  be 
hypnotized  once  every  week  or  two  for  a  year  after  the  cure  has 
been  established,  and  care  be  taken  that  sexual  intercourse  be 
practiced  regularly.  It  should  always  be  remembered  that  the 
period  of  treatment  for  confirmed  habits  is  dependent  upon  the 
time  required  by  the  perversion  for  its  full  development. 

Too,  in  the  severest  cases,  as  we  have  seen,  it  is  possible  to 
remove  onanistic  inclinations  and  sexual  hypereesthesia.  In 
cases  of  contrary  sexuality,  as  a  rule,  after  a  certain  period  of 
treatment  a  state  of  sexual  neutrality  is  established,  in  which 
the  patients  have  become  indifferent  to  homo-sexual  charms, 
but  are  still  insensitive  to  women.  With  the  beginning  of 
regulated  normal  sexual  intercourse,  which,  in  my  opinion,  is 
the  conditio  sine  qua  non  of  cure,  the  feelings  of  disgust,  present 
at  first,  gradually  disappear  entirely ;  the  fancy  of  the  patients 
becomes  more  and  more  impressionable  and  excitable  to  femi- 
nine charms,  and  in  the  transitional  stage  of  psycho-sexual  her- 
maphroditism  care  must  be  taken,  in  external  circumstances,  that 
the  product  of  suggestive  cultivation  gradually  compensates  the 
deeply-rooted  inclination.  The  mental  rudiments  grow  more 
and  more  indistinct,  and  only  cause  relapses  where  occasionally 
sexual  impulses,  unsatisfied  in  the  normal  way,  gain  a  renewed 
mastery  over  the  individual  and,  to  a  certain  extent,  furnish 
new  material  to  the  old  inclination,  whether  this  be  homo- 
sexual, algolagnistic,  or  fetichistic  in  nature.  If,  as  we  have 
previously  tried  to  show,  erTemination  is  a  secondary  manifesta- 
tion of  homo-sexuality,  then,  logically,  the  sexual  transforma- 


CONCLUDING    REMARKS.  305 

tion,  in  the  sense  of  a  male-feeling  individual,  cannot  take  place 
without  affecting  the  mental  life  of  the  individual  concerned, 
even  though  it  must  also  be  admitted  that  such  secondary 
changes  of  character,  in  the  sense  of  weakening,  are  perhaps 
only  fully  developed  in  the  course  of  years,  and  always  require 
long  periods  of  time.  The  theory  of  contrary  sexual  instinct 
and  its  possible  cure  is  still  too  young  to  allow  a  judgment  of 
it  in  this  respect,  based  on  practical  results. 

When,  in  case  of  contrary  sexual  instinct,  cure  is  spoken 
of,  it  is  to  be  understood  only  as  a  relative  cure.  For  absolute 
cure  would  presume  complete  removal  of  the  homo-sexuality, 
its  memory-pictures,  and  a  physical  reflex  effect  of  them  which 
occurs  episodically  in  many  patients.  This,  however,  is  not 
within  human  power.  One  may  be  satisfied  if  these  pictures 
fade  and  become  innocuous  rudiments,  and  if  the  sexual  life  is 
led  into  the  path  of  regular  and  natural  activity. 

If  we  have  been  successful  in  demonstrating  that  this  ther- 
apeutic result,  so  important  for  the  life  of  such  unfortunates, 
may  be  obtained  by  suggestive  treatment ;  that  useful  members 
of  society  can  be  made  of  such  perverted  individuals, — then  the 
object  of  this  work  has  been  attained.  May  it  contribute  to  the 
success  of  the  struggle  with  this  dark  side  of  our  social  life,  and 
open  to  workers  in  the  domain  of  suggestive  therapeutics  a  new 
and  productive  field  of  activity  and  humane  striving ! 


APPENDIX. 


PREPARED  FOB  THE  ENGLISH  EDITION  IN  OCTOBER,  1894 ;  TRANSLATED  FROM 
THE  AUTHOR'S  MANUSCRIPT. 


THE  studies  in  the  pathology  and  therapy  of  psycho-sexual 
anomalies  contained  in  the  foregoing  work  were  published  in 
the  German  for  the  first  time  two  and  one-half  years  ago. 
Though,  during  the  period  that  has  elapsed,  many  new  and  im- 
portant additions  have  been  made  to  the  question  of  sexual  per- 
versions, and  though  views  opposed  to  those  advanced  by  the 
author  have  not  been  wanting,  still  the  contents  of  the  book 
have  retained  the  value  at  first  attributed  to  them.  The  pur- 
pose of  this  appendix  is,  therefore,  the  addition  of  some  not 
unimportant  supplements  to  several  of  the  sections,  as  well  as  to 
a  number  of  histories.  The  following  notes  are  arranged  in 
accordance  with  the  chapters  of  the  book,  and  are  made  as  brief 
as  possible. 

Case  14,  Section  I. — Since  this  patient  was  discharged 
three  and  one-half  years  have  passed.  At  first  the  patient  re- 
mained cured  as  long  as  he  had  opportunity  for  sexual  inter- 
course ;  however,  when  for  any  reason  this  was  not  possible,  he 
masturbated,  but  during  two  years  he  did  not  do  this  more  than 
three  or  four  times.  During  the  last  year  and  a  half  this  has 
not  occurred.  He  attends  to  his  calling  and  feels  himself  per- 
fectly well. 

Case  15,  Section  I. — In  the  meantime  the  patient  has  be- 
come a  physician  and  follows  his  calling  without  further  need 
of  medical  help. 

Case  18,  Section  I. — During  the  two  years  and  a  half  since 
discharge,  the  patient  has  remained  well ;  a  visit  to  her  home 
convinced  me  of  this.  She  has  now  been  happily  married 
several  months.  This  case,  which  has  now  been  under  observa- 
tion, more  than  three  years,  may  be  regarded  as  one  of  the  most 
brilliant  examples  of  the  efficacy  of  suggestive  therapeutics. 

(307) 


308  APPENDIX. 

Case  20,  Section  I. — This  patient  has  remained  cured 
during  the  two  and  one-half  years  that  have  passed.  She 
resumed  her  calling  and  removed  to  another  city.  The  last 
written  report  was  received  three  months  ago. 

Case  35,  Section  II. — In  June,  1894,  two  and  one-half 
years  after  discharge,  this  patient  visited  me  again  to  express 
his  thanks  that  the  mental  treatment  in  1891-92  had  put  him 
on  the  right  road  to  recovery.  The  patient  is  happily  married, 
and  already  the  father  of  one  child ;  he  has  made  himself  inde- 
pendent, and  may  be  regarded  as  definitely  recovered. 

Case  37,  Section  II. — As  may  be  seen  from  the  text,  after 
remaining  well  two  years,  in  October,  1891,  as  a  result  of  severe 
nervous  trouble  the  patient  had  a  relapse,  but  fortunately  he 
came  under  my  treatment  immediately  again.  A  few  hypnotic 
suggestions  again  restored  his  virility,  and  he  has  remained 
well. 

Case  38,  Section  II. — In  November,  1892,  the  patient 
again  presented  himself  and  desired  to  have  the  hypnotic  treat- 
ment resumed,  though  the  success  of  the  previous  treatment  had 
been  lasting,  mainly  with  a  view  to  have  it  become  more  stable, 
— in  reality,  through  fear  of  a  possible  relapse.  Twenty-two 
additional  hypnotic  sittings.  At  the  first  coitus  during  the 
period,  erection  by  means  of  manipulation  by  the  puella ;  then 
slight  emission.  On  the  other  hand,  on  three  other  occasions 
the  patient  had  intercourse  with  complete  satisfaction.  On 
November  27th  the  patient  went  home  with  the  re-assuring 
consciousness  of  complete  virility. 

Case  62,  Section  III. — Since  this  patient  was  discharged 
nearly  four  years  and  six  months  have  passed.  As  I  ascertained 
by  a  personal  interview  with  him,  in  the  interval  he  has  be- 
come the  happy  father  of  three  healthy  children,  whom  he  is 
educating  carefully,  and  whom  he  observes  with  a. view  of  a 
possible  existence  of  any  hereditary  disposition.  As  long  as  R. 
remains  with  his  family  and  is  required  to  lead  a  regular  life  in 
the  small  town  where  he  lives,  he  feels  perfectly  normal  and 
balanced.  He  is  bound  by  love  to  his  wife  and  children,  and 
his  sexual  functions  leave  nothing  to  be  desired.  Occasional 


APPENDIX.  309 

homo-sexual  importunities,  as  on  meeting  former  friends,  he  suc- 
cessfully withstands.  However,  if  B,.  be  on  a  journey  alone  for 
any  length  of  time,  which  occurs  perhaps  once  a  year,  he  still 
finds  pleasure  in  homo-sexual  practices ;  but  this  is  not  from  an 
irresistible  impulse,  nor  from  a  love  of  the  male  sex  or  of  any 
man,  but  to  excite  his  nervous  system  by  the  enjoyment  of  for- 
bidden fruit.  Therefore,  in  this  case,  we  have  to  do  not  with 
an  abnormal  impulse,  not  with  a  relapse,  but  with  the  induc- 
tion of  new  and  exciting  sexual  situations  from  pure  sensu- 
ality, wherein,  however,  the  re-awakening  of  sensual  memory- 
pictures  from  the  past  plays  an  exciting  and  intensifying,  though 
not  determinate,  role.  The  acts  which  five  years  ago  indicated 
desire  of  the  sexual  instinct  have  now  become  simply  acts  of 
vice. 

Case  63,  Section  III. — One  year  after  the  appearance  of 
the  foregoing  work  in  Germany, — that  is,  about  three  years  after 
the  beginning  of  treatment, — I  received  the  following  report  from 
the  patient : — 

March  22,  1893. 

HONORED  BARON  :  In  meeting  your  wishes  by  writing  you  a  few 
lines  concerning  my  health,  I  must  think  what  I  have  to  write, — so  thor- 
oughly have  I  become  accustomed  to  my  new  life.  I  have  intercourse 
regularly  with  women,  but  it  is  only  within  the  last  few  months  that  it 
has  been  regular,  since  that  with  prostitutes  gradually  became  repugnant 
to  me.  What  I  formerly  regarded  as  impossible,  and  what  a  priori  I 
was  forced  to  repel,  I  now  entertain.  I  am  thinking  much  of  marriage ; 
I  imagine  myself  married  ;  long  for  children  and  a  family ;  and  I  think  I 
should  make  a  good,  too  good,  father. 

I  have  no  erotic  fancies,  since  libido  has  greatly  decreased  ;  the  ac- 
companying symptoms  of  the  former  disease — migraine,  depression,  and 
anxiety — have  entirely  disappeared,  so  that  I  am  now  in  a  stable  emo- 
tional condition,  and  I  could  be  entirely  satisfied  were  it  not  for  my  past. 
This,  however,  constantly  comes  up  threatening,  and  to  my  fear  of  it  is 
added  disgust  and  repugnance  of  myself  and  my  former  acts,  such  as 
a  normal  man  must  always  feel  for  contrary  sexual  persons.  The 
memory  of  this  frightful,  debasing  period  will  probably  always  poison 
my  life.  Always  obligated  to  you,  honored  Baron,  in  deepest  gratitude 
I  remain,  Respectfully,  A. 

Since  the  receipt  of  this  report  one  year  and  eight  months 
have  passed,  and  during  that  time  the  patient  has  kept  me  in- 


310  APPENDIX. 

formed  at  long  intervals  concerning  his  condition.  To-day  A. 
feels  masculine ;  neither  in  his  sexual  nor  in  his  psychical  con- 
dition during  this  time  has  he  relapsed,  but  he  has  intercourse 
regularly,  and  has  a  horror  of  sexual  acts  with  his  former  com- 
panions. The  symptoms  of  effemination  have  all  disappeared, 
as  have  all  the  neuropathic  ,  troubles ;  his  appearance  is  healthy 
(brown  complexion) ;  his  manner  shows  more  certainty  and 
assurance;  his  energy  has  increased  and  has  withstood  many 
trials  successfully.  This  latest  verbal  report  I  have  no  reason 
to  doubt ;  the  more  because  of  the  patient's  demonstrated  love 
of  truth,  and  because  his  whole  physical  condition  corroborated 
his  statement.  A.  has  now  been  under  my  observation  five 
years  without  relapse  in  the  last  three  years.  Certainly  the 
most  careful  skeptic  would  allow  the  justice  of  regarding  this 
patient  as  cured.  This  case,  on  account  of  a  complete  effemina- 
tion, is  the  worst  case  of  contrary  sexual  instinct  that  has  ever 
been  reported  cured ;  at  the  same  time,  no  case  where  cure  has 
been  reported  has  been  so  long  under  observation. 

Case  66,  Section  III. — One  year  after  the  appearance  of 
the  German  edition  of  this  work,  or  two  and  one-half  years  after 
the  beginning  of  treatment,  I  received  the  following  letter  from 
this  patient: — 

March  1,  1893. 

HONORED  BARON  :  A  full  year  has  now  passed  since  I  ceased  your 
treatment.  I  am  delighted  that  I  can  give  you  a  most  satisfactory  report 
I  got  on  so  well  that  I  soon  forgot  what  a  sad  condition  I  was  formerly 
in,  and  I  no  longer  thought  of  giving  you  a  report.  Since  I  left  you  I 
have  continued  intercourse  with  women  unchanged.  Gradually  I  felt 
increasing  assurance,  and  in  the  whole  period  it  occurred  but  once  that 
erection  was  not  so  prompt  and  spontaneous  as  usual.  In  this  instance 
I  attribute  the  failure  to  great  fatigue.  While,  during  the  first  months, 
I  sought  women  only  because  I  thought  I  should,  now  I  require  no  such 
stimulus ;  on  the  contrary,  coitus  always  gives  me  intense  pleasure.  In 
proportion  as  pleasure  increased,  the  memory -pictures  of  former  times 
became  less  distinct.  I  have  often  had  occasion  to  come  in  contact  with 
men  whose  appearance  would  formerly  have  immediately  inflamed  my 
passion  ;  now  I  can  be  associated  with  them  without  feeling  the  slightest 
excitement.  The  following  seems  to  me  worthy  of  special  note  : — 

In  May  I  fell  ill  with  rheumatism,  and  part  of  the  time  here  and 
part  of  the  time  at  home  I  was  in  bed  till  the  end  of  June.  Until  my 


APPENDIX.  311 

return  to  Munich,  toward  the  end  of  August, — during  convalescence, — 
circumstances  denied  me  all  possibility  of  coitus.  During  this  time  I  was 
undoubtedly  more  excitable  than  usual ;  but,  notwithstanding  this,  a  meet- 
ing with  a  former  friend  left  me  entirely  cold  sexually,  though  otherwise 
I  thought  much  of  him.  I  was,  at  the  same  time,  as  little  disturbed  by 
the  sight  of  attractive  forms;  I  remained  completely  cold-hearted. 
Briefly,  the  transformation  in  my  entire  manner  of  feeling  is  so  marked 
that  I  formerly  should  have  regarded  it  as  impossible.  In  the  future 
I  hope  to  be  able  to  give  you  as  good  a  report.  With  expressions  of 
constant  gratitude,  I  remain,  Respectfully,  H. 

Since  the  date  of  this  letter  one  year  and  eight  months 
have  passed;  or,  since  the  beginning  of  treatment,  four  and  one- 
half  years.  Some  weeks  ago  (September,  1894)  the  patient 
passed  through  Munich  on  his  wedding-journey  and  visited  me. 
My  expectation  that  at  that  critical  moment  H.  would  require 
renewal  of  treatment  was  entirely  uncalled  for.  H.,  on  the  con- 
trary, seemed  to  be  lastingly  cured,  and  had  not  had  a  single 
relapse.  Intercourse  with  his  young  wife  was  successful  without 
the  help  of  contrary  sexual  ideas.  He  loves  his  wife  dearly,  and 
their  sexual  relations  are  perfectly  normal.  Besides,  his  outward 
appearance  is  that  of  blooming  health  and  manliness.  The  pa- 
tient's brother,  who  is  acquainted  with  his  entire  sexual  life  and 
who  observed  his  transformation,  confirms  H.'s  statements.  I 
am  also  justified  in  regarding  this  patient  as  completely  cured. 

Case  67 ',  Section  III. — Soon  after  the  appearance  of  the 
German  edition  of  this  book  (summer  of  1892)  this  patient  dis- 
continued treatment,  notwithstanding  the  fact  that  the  improve- 
ment obtained  justified  a  favorable  prognosis  as  to  cure. 

Impelled  by  unfortunate  circumstances  of  business  and 
finances,  in  the  fall  of  1892,  the  patient  carried  out  the  idea  he 
had  long  entertained,  and  brought  his  unfortunate  life  to  an  end 
by  shooting. 

Case  68,  Section  III. — The  restoration  of  this  patient  by 
suggestive  treatment  has  not  been  undertaken  because  business 
circumstances  have  not  allowed  him  time  for  treatment.  In 
December,  1893,  he  informed  me  also  that  he  was  convinced  of 
the  hopelessness  of  his  condition  (a  belief  with  which  I  can- 
not agree).  He  states  that  he  has  never  been  successful  in  the 


312  APPENDIX. 

onanistic  act ;  at  the  same  time  he  is  doubtful  about  mar- 
riage, because  of  the  possibility  of  tainting  descendants.  Led 
by  reading  Moll's  work,  he  forced  himself  to  entertain  hetero- 
sexual fancies.  In  his  opinion  this  led  only  to  neurasthenic 
troubles.  He  continues:  "In  contrast  with  all  this  I  have  the 
greatest  desire  to  have  a  family,  but  I  must  accustom  myself  to 
the  inevitable.  I  repeat  what  I  told  you  verbally, — that  I  suffer 
most  from  this  deprivation,  while  the  contrary  sexual  feeling 
per  se  and  the  necessary  abstinence  cause  me  no  trouble. 
Apparently  this  is  due  to  my  moderate  sensuality,  which  is 
satisfied  by  the  sight  and  occasional  hand-pressure  and  touch 
of  the  party  in  question.  My  general  condition  is  good  ;  there 
is  no  trace  of  neurasthenic  trouble,"  etc. 

Thus,  my  conclusions  reached  in  this  case  in  the  text  are 
still  justified. 

Case  69,  'Section  IIL — The  sexual  condition  of  this  patient 
became  perfectly  normal  through  regulated  sexual  intercourse, 
as  he  informed  me  some  years  after  discharge.  To-day  he  is 
happily  married  and  the  father  of  several  children. 

Case  70,  Section  IIL — This  patient  died,  one  and  a  half 
years  after  the  appearance  of  the  German  edition  of  this  work, 
of  tuberculosis ;  and  he  never  fully  recovered,  in  the  interval, 
from  the  effects  of  the  influenza  mentioned  in  the  text. 

Concerning  the  cases  in  the  text  not  mentioned  here,  it  has 
been  impossible  for  me  to  obtain  later  information. 


Numerous  new  cases  likewise  confirm  the  author  in  the 
correctness  of  the  etiological  and  therapeutic  deductions  of  the 
text.  However,  von  Krafft-Ebing,1  though  the  ninth  edition 
of  his  work  has  already  appeared  in  German,  has  not  changed 
his  views,  but  has  sought  to  strengthen  his  theory  of  herdi- 
tary  taint  by  embryological  and  anthropological  facts.  Thus  he 
recalls  the  original  bisexual  nature  of  the  human  sexual  glands 
with  the  related  sexual  organs,  and  also  that  the  beginning  of 

1  Von  Krafft-Ebing,  "  Zur  Erklarung  der  Contraren  Sexualempflndung,"  Jahr- 
bucher  far  Psychiatric  u.  Nervenkrankheiten,  Bd.  xiii,  Heft  1. 


APPENDIX.  313 

development  in  a  mono-sexual  sense  takes  place  first  at  the  end 
of  the  third  month  of  foetal  life.  Too,  in  accordance  with  von 
Krafft-Ebing's  hypothesis,  the  spinal  and  cerebral  centres  stand- 
ing in  relation  with  the  sexual  organs  must  also  embryonically 
be  possessed  of  a  bisexual  nature  (^).  Half  of  this  embryonic 
possibility  becomes  latent ;  normally  the  other  half,  correspond- 
ing with  the  sexual  glands  which  attain  development,  develops 
fully.  In  the  male,  the  residua  which  indicate  the  original 
ontogenetic  and  phylogenetic  bisexual  possibility  are  the  Miil- 
lerian  ducts,  the  utriculus  masculinus  (vesicula  prostatua) ;  in 
the  female,  the  paroophoron  as  the  remains  of  the  original 
nephritic  portion  of  the  Wolffian  body  and  as  the  analogue  of 
the  male  epididymis.  Under  pathological  conditions,  the  author 
(von  Krafft-Ebing)  assumes  the  virtual  continued  existence  of 
the  hypothetical  cerebral  and  spinal  centres  corresponding  with 
the  latter,  as  a  result  of  imperfect  inhibition  of  them,  which 
may  even  be  of  such  degree  as  to  allow  active  exercise  of  their 
influence  upon  the  production  of  the  physical  and  psychical 
sexual  characteristics, — indeed,  in  infrequent  cases,  deposing  the 
former  from  their  normal  domination,  and  leading  to  the  devel- 
opment of  a  sexuality  corresponding  with  the  latter  centres  and 
out  of  harmony  with  the  sexual  organs. 

The  correctness  of  this  new  and  ingenious  hypothetical  ex- 
planation can  only  be  allowed  after  the  existence  of  rudimentary 
spinal  and  cerebral  centres  has  been  anatomically  demonstrated. 
However,  the  psycho-sexual  condition  of  hermaphrodites,  which 
von  KrafFt-Ebing  also  seeks  to  use  as  a  support  for  this  view, 
speaks  much  rather  for  an  opposite  opinion, — namely,  for  the 
great  importance  of  exogenous  factors.  Laurent,1  in  his  latest 
work,  collects  all  the  known  cases  of  hermaphroditism,  and, 
concerning  the  determining  role  of  education  in  the  sexual  life, 
expresses  himself  as  follows :  "  In  many  cases  education  is  capa- 
ble of  forcing  the  sexual  instinct  in  a  direction  opposed  to  that 
which  should  be  taken,  and  of  producing  thus  a  kind  of  sexual 
inversion."  On  the  whole,  however,  he  regards  such  cases  as 
degenerates  of  inferior  mental  endowment,  who  much  more 

1  Laurent,  Les  bisexues.     Paris,  Carre,  1894. 


314  APPENDIX. 

frequently  become  the  victims  of  vice  and  prostitution  than  of 
love ;  the  majority  are,  in  his  opinion,  indifferent  from  a  sexual 
stand-point.  The  same  author  designates  those  men  as  gynseco- 
masts  whose  sexual  organs  have  not  attained  complete  develop- 
ment. As  the  only  bodily  attribute  of  the  female,  they  possess 
feminine  breasts.  While  in  conformity  with  the  anthropological 
transformation,  according  to  the  theory  of  von  Krafft-Ebing,  one 
would  be  led  to  assume  at  least  the  existence  of  a  partial  inver- 
sion of  the  vita  sexualis  in  these  cases,  Laurent  gives  a  number 
of  detailed  observations  in  which  the  sexual  life  was  entirely 
developed  in  a  masculine  direction  ;  and  the  observations  of  the 
author  (von  Schrenck)  of  bearded  women  and  of  men  with 
feminine  breasts  are  in  entire  accord  with  those  of  Laurent. 
Laurent  questioned  all  gynaecomasts  that  came  under  his  obser- 
vation concerning  their  vita  sexualis. 

In  spite  of  their  emphatic  denials,  and  without  any  certain 
proof,  Laurent  presumed  that  but  two  (!)  of  them  had  inclina- 
tions to  sodomy  (p.  97).  From  this  the  occurrence  of  an 
invariable  or  frequent  correspondence  of  feminine  physical  char- 
acteristics with  feminine  sexual  feelings  in  the  male,  and  the 
opposite  in  the  female,  must  be  regarded  as  in  nowise  demon- 
strated. With  each  single  case  that  speaks  in  favor  of  it,  similar 
cases  with  an  opposite  psychical  condition  may  be  brought  in 
contrast.  The  determination  of  this  question  will  depend  prin- 
cipally upon  the  embryological  and  psychological  conception  of 
the  sexual  instinct. 

Meynert,1  in  his  clinical  lectures  (not  cited  in  the  text),  ex- 
presses himself  on  this  point  as  follows :  "  There  is  little  sense 
in  assuming  an  inborn  tendency  with  peculiarity  of  organization 
that  leads  to  the  idea  of  a  female  soul  in  a  male  body  or  a 
male  soul  in  a  female  body.  Instincts  (impulses)  are  in  no  sense 
the  result  of  our  brain  activity,  but  merely  words.  There  is  a 
feeling  of  hunger,  but  no  instinct  for  food.  In  the  feeling  of 
hunger  the  child  has  no  notion  of  the  means  to  still  it ;  it  leads 
to  death,  or  the  child  is  suckled.  Then  the  sucking-reflex  acts, 
and  the  child  experiences  the  sensation  of  satisfied  hunger  with 

1  Klinische  Vorlesungen  iiber  Psychiatric.    Wien,  Braunmiiller,  1890. 


APPENDIX.  315 

which  the  act  of  sucking  is  associated,  which  now  becomes  a 
cortical  movement,  associated  with  the  feeling  of  hunger,  the 
odor  of  the  nipple,  and  the  taste  of  the  milk.  Where,  between 
reflex  and  cortical  movement,  lies  the  third  factor — the  instinct 
— a  congenital  idea1?  There  are  tactile  sexual  sensations  arising 
from  the  corpora  cavernosa,  but  no  inborn  instinct  in  them. 
The  influences  which  from  them  develop  sexual  activity  are 
occasional  perceptions,  tradition,  imitation,  but  never  any  con- 
genital ideas,  and,  therefore,  never  any  congenital  anomalies  of 
thought."  Meynert  was  also  always  able  to  prove  the  exciting 
cause  of  contrary  sexual  feeling  in  his  patients. 

While  Moll,1  in  the  second  edition  of  his  work,  emphasizes 
still  more  the  theory  of  hereditary  taint  of  von  Krafft-Ebing, 
and  regards  our  demonstration  as  weak, — a  new  capitatio  benev- 
olentice  for  the  numerous  homo-sexual  individuals, — Eulen- 
burg,2  in  a  recent  publication,  however,  declares  that  in  the 
future,  in  the  judgment  of  such  patients,  the  exciting  and  acci- 
dental factors  and  their  influence  upon  development  will  require 
more  careful  investigation  than  has  heretofore  been  used.  He 
holds  it  unproven  that  such  factors  can  alone  lead  to  contrary 
sexual  feeling.  On  the  other  hand,  in  the  precocious  awaken- 
ing of  the  sexual  instinct,  Eulenburg  sees  a  clear  indication 
of  the  presence  of  pronounced  contrary  sexual  instinct.  In 
opposition  to  this,  as  has  been  emphasized  in  the  text,  the  neu- 
ropathic taint  present  in  such  persons,  which  allows  the  prema- 
ture awakening  of  the  sexual  impulse,  but  without  reference  to 
its  object,  is  to  be  taken  into  consideration.  In  the  abnormal 
neuro-psychical  taint,  or,  better,  weakness,  which  Eulenburg 
regards  as  a  conditio  sine  qua  non  in  all  these  patients,  also  lies 
the  impossibility  of  correction  by  means  of  later  opposing  per- 
ceptions of  the  sexual  life.  My  explanations,  which  rest  upon 
the  psychological  (folk)  origin  of  uranism  and  upon  pathological 
association,  which  my  opponents  allow  in  fetichism,  have  not  as 
yet  been  vitiated  by  either  Eulenburg,  Moll,  or  von  Krafft- 
Ebing.  The  fact  remains  unchanged :  "  Through  exogenous 

1  Die  contrarie  Sexualempfindung.     Berlin,  Kornfeld,  1893. 

5  "  Neuropathia  sexualis  virorum,"  Klinieches  Haudbuch  der  Harn-  und  Sexual- 
orgaue,  Abth.  iv,  1893.  Leipzig,  Vogel. 


316  APPENDIX. 

stimuli  and  perceptions  the  content  of  such  sexual  imperative 
feelings,  or  ideas,  are  supplied  to  such  tainted  persons,  and 
through  these  a  complete  sexual  transformation  may  take 
place." 

Eulenburg  designates  parsesthesia  sexualis  as  parerosia,  and 
correctly  concludes,  from  his  premises,  that  a  transformation 
of  the  pathological  homo-sexual  condition  to  a  normal  hetero- 
sexual condition  is  not  artificially  possible.  My  three  cured  cases 
(62,  63,  66),  observed  almost  five  years  continuously,  prove 
exactly  the  opposite.  However,  Eulenburg  speaks  warmly  in 
favor  of  psychical  treatment  by  suggestion.  Appreciation  and 
sympathy  with  such  patients  are  necessary  for  the  attainment 
of  decided  effects.  From  a  number  of  recent  cases  the  author 
(von  Schrenck)  is  forced  to  regard  the  establishment  of  regular 
sexual  intercourse  as  the  principal  requirement  for  cure.  In 
cases  in  which,  out  of  repugnance  and  whim,  such  patients  did 
not  fulfill  this  requirement,  no  deep  and  lasting  success  could  be 
attained.  The  favorable  reaction  of  hetero-sextial  relations  upon 
the  mind  of  these  patients,  even  though  had  at  first  without 
marked  feeling  of  pleasure,  was  very  seldom  wanting.  There 
are  infrequent  exceptions,  as  in  persons  devoid  of  lively  sexual 
impulse,  or  in  those  that  are  more  than  40  years  old.  But 
even  in  such  individuals  sometimes  the  dream-life  is  lastingly 
influenced.  The  dream-pictures  accompanying  occasional  pol- 
lutions take  their  subjects  rather  from  mental  associations, 
strengthened  by  habit  and  deepened  sensory  impressions  from  the 
past,  than  from  the  weaker  (so  to  speak)  and  purely  theoretical 
influences  of  verbal  suggestion. 

Among  the  authors  that  have  accepted  the  etiological 
explanation  set  forth  in  this  work,  Krapelin  l  should  be  men- 
tioned first.  He  is  in  accord  with  the  writer  in  this,  that  the 
abnormality  in  the  so-called  contrary  sexual  feeling  resting  upon 
hereditary  taint  depends  upon  the  peculiar  impressionability  of 
the  prematurely-awakened  instinct,  which  in  turn  depends  upon 
the  degeneracy.  Through  this  the  youthful  sensibility  is  last- 
ingly influenced  by  the  first  excitation  of  sensual  feeling.  In 

1  Psychiatric,  4te  Aufl.,  Leipzig,  1893,  p.  691. 


APPENDIX.  317 

accordance  with  this,  the  prognosis  in  such  cases  is  the  more 
favorable. 

Without  reference  to  our  etiological  explanation,  following 
Meynert  and  Binet,  and  published  in  1892,  Sioli,1  in  1894,  in 
an  article  on  perverse  sexual  instinct,  expresses  the  same  view. 
"  There  is  the  same  weakness  of  judgment,  of  association, 
which  we  conceive  from  an  anatomico-physiological  stand-point, 
as  (1)  a  deficiency,  (2)  a  weakness,  of  the  association-paths,  as 
the  foundation  of  all  cases,  which  we  are  accustomed  to  desig- 
nate in  common  as  hereditarily  degenerate,  as  predisposed ;  in 
all  these  cases  the  perverse  impulses  arise  only  as  a  result  of 
the  circumstance  that  with  the  increase  and  union  of  memory- 
pictures  the  normal  correction,  the  influence  upon  thought  and 
action  of  the  subsidiary,  inhibitory,  and  opposing  ideas,  by 
means  of  the  association-paths  present  in  normal  persons,  are 
wanting,  because  these  paths  in  these  cases  are  absent."  Thus, 
according  to  Sioli,  arise  the  abnormal  manifestations  and  acts 
which  have  led  to  the  assumption  of  abnormal  instincts,  while, 
in  fact,  the  cases  are  no  more  than  instances  of  mental  weak- 
ness and  inability  to  correct  the  association  of  external  impres- 
sions which  determine  all  acts.  As  a  result  of  the  weakness  of 
psychical  association,  the  bodily  sensations  enter  into  conscious- 
ness— that  is,  into  general  thought  and  feeling — in  a  greatly- 
intensified  degree. 

The  organic  sensations  arising  from  the  sexual  organs,  in 
those  patients  afflicted  with  a  weakened  associative  system,  early 
exercise  a  powerful  influence.  As  a  result  of  these  sensations, 
at  first  indefinite,  arise  handling  and  onanistic  manipulations. 

Accidental  circumstances  become  associated  with  the  sexual 
stimulus.  Then,  as  soon  as  the  pathological  impulse  has  become 
a  habit,  the  individual,  as  a  result  of  his  weakness  of  associa- 
tion,^ incapable  of  attaining  to  an  understanding  of  the  normal 
relations  with  woman.  Sioli  finally  very  justly  calls  attention  to 
the  symptom  of  fallacy  of  memory,  which  is  likewise  explained 
by  the  weakness  of  association, — a  symptom  that,  for  the  most 
part,  has  been  insufficiently  considered. 

1  "  Ueber  perverse  Sexualempflndung,"  Zeitschr.  fur  Psychiatric,  1894,  Bd.  1,  Heft  5. 


318  APPENDIX. 

Geill1  takes  a  middle  ground.  He  fully  allows  the  impor- 
tance of  injurious  sexual  influences  in  neuropathic  individuals 
during  development.  However,  according  to  him,  such  influ- 
ences have  no  significance  in  congenital  contrary  sexual  instinct. 
Such  individuals  exhibit  a  congenital  weakness  of  the  vita 
sexualis, — indeed,  often  of  the  entire  feeling. 

For  the  perverse  manifestations  of  the  sexual  life  included 
by  von  KrafFt-Ebing  in  the  terms  sadism  and  masochism  Eulen- 
burg  has  adopted  the  word  algolagny,  suggested  by  the  writer, 
in  his  work  previously  cited.  As  a  reason  for  this,  Eulenburg 
rightly  states  that  the  active  commission  of  painful  acts  for  the 
purpose  of  sexual  gratification  is  in  no  sense  characteristic  of 
the  stories  of  the  Marquis  de  Sade,  and  that  the  passive  role  is 
as  little  so  of  the  heroes  and  heroines  of  the  novels  of  Sacher- 
Masoch.  Besides  (and  in  this  I  agree  fully  with  Eulenburg),  the 
acts  of  sexual  cruelty  are  by  no  means  exhausted  by  the  active 
and  passive  roles.  In  opposition  to  the  terms  used  by  v.  KrafFt- 
Ebing,  the  writer  would  remark  that  this  manner  of  sexual 
gratification  is  much  older  than  the  works  of  Sade  and  Masoch, 
and  that  it  has  played  an  important  part  in  history  (e.g.,  in  the 
Church),  especially  in  ancient  history.  Moreover,  there  is  an 
onanistic  algolagny,  which  I  have  lately  had  opportunity  to 
observe,  and  under  which  many  cases  of  auto-flagellation  are  to 
be  classified ;  further,  a  visual  algolagny,  i.e.,  sexual  excitement 
at  the  sight  of  punishment ;  and  a  zob'pliilia  and  bestial  algo- 
lagny, as  soon  as  the  lust  for  cruelty  is  related  to  animals. 
Where  there  is  merely  the  intensification  of  such  a  scene,  the 
condition  could  be  called  symbolic  algolagny.  The  violation  of 
corpses,  in  this  sense,  when  maltreatment  of  the  body  was 
associated  with  it,  would  be  necrophilic  algolagny,  and  it  would 
be  differentiated  from  simple  necrophilia  in  that  the  latter,  as 
the  word  signifies,  includes  only  caresses  of  the  body.  Further, 
I  have  had  opportunity  to  observe  cases  in  which  the  pain  per 
se  played  the  principal  role,  without  reference  to  its  active  or 
passive  nature.  Such  patients  are  algolagnists  in  the  true  sense. 

1  "  Die  Lehre  von  der  Psychopathla  Sexualis  und  ihre  gerlchtsarztliche  Bedeutung," 
Ugeskrift  for  Lagert,  R.  xxvii,  Nr.  27-33. 


APPENDIX.  319 

Moreover,  the  tyrannical  feeling  of  absolute  mastery  or  of  com- 
plete subjection,  which  von  Krafft-Ebing  regards  as  character- 
istic of  sadism  and  masochism,  is  by  no  means  always  combined 
with  algolagny,  and  therefore  it  can  in  no  way  be  used  to  deter- 
mine the  condition.  So  much  for  the  strengthening  of  the  term 
proposed. 

On  the  question  of  the  responsibility  of  sexual  perverts,  in 
Section  III  of  this  work  the  view  was  expressed  that  the  isolated 
existence  of  perverse  manifestations  of  the  sexual  instinct  gave 
rise  in  no  sense  to  irresponsibility.'  This  statement,  further 
emphasized  in  Chapter  X,  has  received  new  support  in  the 
excellent  expositions  of  Sommer1  concerning  criminal  psychol- 
ogy and  penal  laws.  According  to  his  view,  the  proof  of  the 
endogenous  nature  of  a  certain  mental  state  is  not  sufficient  to 
establish  the  existence  of  mental  disease.  He  extends  this 
thesis  especially  to  the  domain  of  psycho-sexual  anomalies. 
According  to  Sommer,  when  it  is  proven  that  a  person,  from 
endogenous  disposition,  is  perverse, — e.g.,  when  a  man  is  excited 
(sexually)  by  another, — he  should  be  punished  for  a  correspond- 
ing act  when  the  act  falls  within  those  that  are  punishable. 
"  Human  society  has  the  same  right,"  he  continues,  "  to  demand 
control  of  the  endogenous  impulse  in  general  that  it  has  to 
demand  it  in  cases  of  congenital  allo-sexual  instinct  when  it  is 
directed  against  a  child  of  the  opposite  sex ;  or  that  the 
impulses  to  possess  the  property  of  others  be  repressed.  There- 
fore, if  these  perverts  are  to  be  made  free 'from  punishment, 
this  is  not  to  be  done  during  the  existence  of  the  present  laws 
by  declaring  them  insane,  but  by  changing  the  laws.  The 
decision  of  this  question  is  not  to  be  made  by  psychiatry,  but 
by  public  opinion,  in  so  far  as  it  may  be  the  expression  of  the 
actual  moral  will  of  the  great  majority  of  the  people.  As  long 
as  the  moral  ideas  of  the  majority  of  the  people  are  opposed  to 
homo-sexual  acts  and  the  laws  give  expression  to  these  ideas, 
the  so-called  contrary-sexual  persons  must  control  their  impulses, 
as  the  man  who,  hungry,  must  control  his  impulse  to  possess 

1  "  Krirninalpsychologie  und  Strafgesetzgebung,"  Deutech.  MediciDalzeitung,  Oct. 
10, 1894,  p.  890  et  seq. 


320  APPENDIX. 

himself  of  the  property  of  others.  At  most,  it  might  be  said 
that  the  gratification  of  homo-sexual  inclinations  was  a  private 
matter  between  two  persons,  which  does  not  harm  society  as 
long  as  scandal  is  not  excited  by  it.  There  seems  to  be  no 
doubt,  however,  that  among  those  persons  that  indulge  in  homo- 
sexual acts  there  are  many  insane  individuals." 

According  to  Sommer,  endogenous  antisocial  impulses 
(among  which  those  in  question  are  to  be  reckoned),  like  en- 
dogenous instincts,  should  not  be  punished,  but  they  should 
not  be  taken  as  evidence  of  insanity. 

The  notes  in  this  appendix  in  all  respects  confirm  and 
enlarge  the  facts  published  in  this  work  two  years  ago.  The 
principal  task  of  further  investigation  must  be  the  publication 
of  additional  observations,  in  order  to  decide  definitely  the 
question  of  congenital  contrary  sexuality  and  other  varieties  of 
perverse  sexual  feeling  in  their  psychological,  pathological,  and 
forensic  aspects. 


1896. 


Catalogue  of  the  Publications 

of 

THE  F.  A.   DAVIS  CO., 
/Medical  Publishers  ^  Booksellers, 

PHILADELPHIA,  PA. 


PHILADELPHIA :  1914-16  Cherry  Street. 
NEW  YORK:  117  W.  Forty-Second  Street. 
CHICAGO :  9  Lakeside  Building,  214-220  S.  Clark  Street. 

ORDER  FROM  NEAREST  OFFICE. 

FOR  SALE  BY  ALL  BOOKSELLERS. 


Prices  of  books,  as  given  in  our  catalogue  or  circu- 
lars, include  full  prepayment  of  postage,  freight,  or 
express  charges.  Customers  in  Canada  or  Mexico  must 
pay  the  cost  of  duty,  in  addition,  at  point  of  destination. 

We  do  not  hold  ourselves  responsible  for  books  sent 
by  mail ;  to  insure  safe  arrival  of  books  sent  to  distant 
parts,  the  package  should  be  registered.  Charges  for 
registering  (at  purchaser's  expense),  8  cents  for  even' 
four  pounds  or  less. 

N.B.— Remittances  should  be  made  by  Express  Money-Order, 
Post-Office  Money-Order,  Registered  Letter,  or  Draft  on  New 
York  City,  Philadelphia,  Boston,  or  Chicago.  Money  sent  in  any 
other  way  must  be  entirely  at  risk  of  sender. 


1  2 

•A.  ••«•< 


THE  ATTENTION 


is 

DIRECTED  TO  THE  FOLLOWING  STANDARD  TEXT-  AND 

REFERENCE-  BOOKS  ANNOUNCED  IN 

THIS  CATALOGUE: 

BOENNING— Practical  Anatomy.    Page  3. 

CATHELL— Book  on  the  Physician  Himself.    Tenth  Edition.    Page  4. 

EDINGER— Structure  of  the  Central  Nervous  System.    Page  5. 

EISENBERG— Bacteriological  Diagnosis.    Page  5. 

GANT— Diseases  of  the  Rectum  and  Anus.    Page  5. 

GRANDIN  and  JARMAN— Obstetric  Surgery.    Page  6. 

GRANDIN  and  JARMAN— Pregnancy,  Labor,  and  the  Puerperal 
State.  Page  6. 

GRANDIN  and  JARMAN— Practical  Obstetrics.    Page  6. 

International  Text-Book  of  Medical  Electro-Physics  and  Galvan- 
ism. Page  7. 

IVINS— Diseases  of  the  Nose  and  Throat.    Page  7. 

LIEBIG  and  ROHE— Electricity  in  Medicine  and  Surgery.    Page  8. 

riANTON — Syllabus  of  Lectures  on  Human  Embryology.  Second 
Edition.  Page  8. 

PURDY— Practical  Uranalysis  and  Urinary  Diagnosis.  Second 
Edition.  Page  10. 

ROHE— Text-Book  of  Hygiene.     Third  Edition.     Page  11. 

ROHE— Practical  Manual  of  Skin  Diseases.    Page  11. 

SENN— Principles  of  Surgery.     Second  Edition.     Page  12. 

SENN— Tuberculosis  of  Bones  and  Joints.    Page  12. 

SHOEriAKER— Materia  Medica  and  Therapeutics.  Third  Edition. 
Page  12. 

SMITH— Physiology  of  the  Domestic  Animals.    Page  12. 

STEWART— Obstetric  Synopsis.     Page  13. 

YOUNG— Synopsis  of  Human  Anatomy.    Page  14. 

RANNEY— Lectures  on  Nervous  Diseases.    Page  15. 

SAJOUS— Lectures  on  Diseases  of  the  Nose  and  Throat.    Page  15. 

The  above  books  can  be  examined  and  obtained 
at  address  given  on  Title-page  of  this  Catalogue, 
and  of  booksellers  generally. 


Illllll  I'll "')'  "f' *       11  n  A    Q  O  £•> 


Jlfii* 

-•^B^A-J 


.;      ]> 

jm 

••*£** 
ii¥i\ 

km 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

405  Hilgard  Avenue,  Los  Angeles,  CA  90024-1388 

Return  this  material  to  the  library 

from  which  it  was  borrowed. 


e 


INI 


ar/ 


'''$A-f  VJS&to 


